This article was originally published March 26, 2020. New information has been added for Alabama, California, Connecticut, Florida, Georgia, Indiana, Louisiana, Maine, Maryland, Michigan, New Hampshire, New Jersey, New York, North Carolina, Rhode Island, Texas, Washington, and Wisconsin.
At the beginning of this article series at the onset of the COVID-19 pandemic, states moved with varying speeds in imposing restrictions on individuals and business in stay-at-home orders and orders prohibiting or restricting elective medical procedures. Since late spring, states have moved at different speeds in lifting these restrictions to open the economy and allow elective medical care, while sometimes having to reimpose restrictions.
At the current time, states are no longer imposing the more severe stay-at-home mandates or outright prohibiting elective procedures, but instead are putting in place measures meant to address safety concerns while still letting the country get back to work. As the states have reached a stasis on allowing business and healthcare activities, this will be the final update to this series.
Individual State Orders. We have prepared a succinct state-by-state summary and color-coded map of individual directives and orders that impact healthcare providers and elective procedures. Please click below to expand to view any orders and directives that are applicable to your state. This information is recent as of 12 p.m. ET on October 13, 2020, and will be updated regularly.
A decision whether a procedure or surgery is elective or should be postponed or canceled under any state directive to do so is a clinical determination that each provider and facility must determine based on the risks and benefits of each case.
In determining whether to proceed with a procedure, providers must take care to heed any executive orders from their states, local governments, or other directives from agencies such as a Department of Health and should consult and consider the CDC and CMS guidelines.
As noted above, while no state nor CMS nor the CDC appears to have yet indicated any specific documentation that must be maintained (recognizing that in all matters related to COVID-19, the situation is fluid and ever-changing), we recommend that providers ensure they maintain proper documentation of the risk analysis performed in determining to forward with a procedure or surgery. McGuireWoods stands ready to assist and has developed and is continuing to develop forms for such purposes.
Stay-at-Home. On March 19, 2020, Alabama State Health Officer Scott Harris issued an order directing the closure of many non-essential businesses as well as putting in place parameters for the continued operation of certain businesses. The order does not affect healthcare providers and facilities. On April 3, 2020, Harris issued an order requiring all Alabama residents to stay at their place of residence, apart from certain essential activities. The order is effective through at least April 30, 2020.
Stay-at-Home Update. On April 28, Gov. Kay Ivey announced a safer-at-home order that will be in effect from 5 p.m. on April 30 through May 15 and will replace the prior stay-at-home order that expires April 30. The safer-at-home order recommends that all individuals, and especially vulnerable people, minimize travel, wear face masks when leaving the home and practice disinfecting techniques. Those who have tested positive for COVID-19 will continue to be required to quarantine in their resident for 14 days. Non-work-related gatherings of 10 or more, or of any size that cannot maintain social distancing, are still prohibited. All employers, unless otherwise excepted, must take reasonable steps to protect their employees by following recommendations such as avoiding gatherings of 10 or more, maintaining social distancing, regularly disinfecting, and facilitating remote work. Retail stores may open, but must limit occupancy to 50 percent and follow social distancing and sanitation guidelines. A number of business types considered high-risk may not open, including entertainment venues, athletic facilities and service providers such as salons.
Stay-at-Home Update. On May 8, 2020, Gov. Kay Ivey issued an updated safer-at-home order, effective May 11 – 22, 2020, that allows more businesses to open and amends restrictions on businesses and individuals. The order rescinds the 10-person limit on gatherings as long as social distancing of six feet is maintained, allows in-person dining as long as social distancing of six feet between tables is maintained, allows the reopening of athletic facilities such as gyms as long as distancing is maintained, and continues to require enhanced sanitation procedures. Entertainment venues and schools will remain closed. Hospitals and nursing homes still must restrict visitation and non-essential healthcare personnel, with exceptions for compassionate care visitation.
Stay-at-Home Update. Gov. Kay Ivey amended the state’s safer-at-home order on May 21, effective through July 3, 2020, further loosening restrictions on business operations and personal travel. The order provides that entertainment venues such as bowling alleys, concert venues, theaters, tourist attractions such as museums, and playgrounds could open and operate (subject to occupancy limits, social distancing and sanitation requirements) as of May 23. Further, athletic activities such as team sports could begin on May 23. The order places additional requirements on schools and colleges to operate on June 1. Child care facilities and day and overnight camps also could begin operations on May 23.
Stay-at-Home Update. Gov. Kay Ivey issued an amended safer-at-home order on June 30, 2020, which essentially extends until July 31, 2020, the prior order that was set to expire on July 3.
Stay-at-Home Update. Gov. Kay Ivey issued an amended safer-at-home order on July 15, 2020, that included a stateside mask mandate, requiring individuals to wear face coverings whenever in public and in close contact with other people
Stay-at-Home Update. Gov. Kay Ivey issued an amended safer-at-home order on Aug. 27, 2020, in effect until Oct. 2, 2020, that continues the state’s mandate requiring face masks whenever people are indoors in places open to the general public, or outdoors in a public space where 10 or more people are gathered. Those testing positive for COVID-19 must quarantine themselves in their residence. The order continues prior orders’ requirements for businesses to maintain social distancing and sanitation procedures.
Stay-at-Home Update. Gov. Kay Ivey issued her 18th emergency order on Sept. 30, 2020, effective until Nov. 8, 2020, essentially continuing her prior orders placing requirements for safe operation of the state’s economy on individuals and businesses. This order also contained a statewide mask mandate.
Elective Procedures. The March 19 order also notes that as of the date of the order, all elective and dental medical procedures shall be delayed. The order does not provide any additional guidance on what constitutes an elective procedure. Therefore, we recommend providers continue to utilize the CMS guidelines.
Elective Procedures Update. As part of the state’s safer-at-home order, effective 5 p.m. on April 30, dental, medical and surgical procedures may proceed unless the state health officer determines that such procedures (either statewide or regionally) should not proceed based on the unacceptable reduction of medical equipment and supplies such as PPE. Providers are directed to follow any applicable rules promulgated by a state regulatory authority or the Department of Health. If no such rules are available, providers must take reasonable steps to comply with CDC and CMS guidelines to provide non-COVID-19-related care.
Stay-at-Home. Alaska Gov. Mike Dunleavy issued Health Mandate 12, effective March 28, 2020, which was updated on April 9 to extend the effective date through April 21, 2020. It prohibits all in-state travel between communities, whether resident, worker or visitor, unless the travel is necessary to support critical infrastructure or for critical personal needs. Critical personal needs include travel for receiving essential healthcare. Further, healthcare operations have already been deemed critical infrastructure allowing for travel and work and were previously defined to include hospitals, clinics, dental emergency services, pharmacies, other healthcare facilities, home healthcare services and providers, mental health providers, companies and institutions involved in the research and development, manufacture, distribution, warehousing, and supplying of pharmaceuticals, biotechnology therapies, consumer health products, medical devices, diagnostics, equipment, services, or any related and/or ancillary healthcare services. Healthcare operations also include veterinary care.
Stay-at-Home Update. Gov. Dunleavy issued Health Mandate 16, or the Reopen Alaska Responsibly Plan, on April 22. The order goes into effect April 24, and includes five attachments addressing specific types of businesses, such as non-essential public-facing businesses generally, retail businesses, restaurant dine-in services, personal care services and non-essential non-public-facing businesses. Each of these attachments acts as a modification of a prior health mandate and allows the category of businesses to resume operations if they meet all listed requirements. These requirements include measures to address social distancing (such as specific restrictions on the number of customers), hygiene protocols, staffing measures such as employee screening, and cleaning and disinfecting requirements.
Stay-at-Home Update. Gov. Mike Dunleavy announced on May 22 that the state was moving to phase three of the state’s reopen plan. Under phase three, all businesses, religious houses of worship, libraries, museums, recreational activities, and sports activities could reopen at 100 percent of capacity. The phase three plan also continues to include guidelines for specific business types, including retail, child care, camps, mass transit, personal services, restaurants, fitness centers, swimming pools and entertainment venues.
Elective Procedures. While Gov. Dunleavy issued Health Mandates 006 and 007 on March 19, 2020, requiring the postponement of all elective dental procedures for a period of one month and the postponement or cancellation of all elective or non-urgent medical procedures for a period of three months. Regarding dental procedures, the mandate recommends the following actions:
- Prioritize treatment for patients experiencing dental emergencies, defined by the ADA as “Health care related to relief of severe dental/oral pain and infection management.”
- To help decrease the overburden on emergency rooms and urgent care facilities as the COVID-19 response rapidly increases, oral health practitioners are encouraged to provide emergency dental care through patients’ regular dental home, including after-hours where possible, except in the case of a life-threatening emergency.
- Limit orders and use of PPE to the minimum necessary for emergency care.
Regarding medical procedures, elective and non-urgent medical procedures include pre-scheduled surgeries that are deemed non-essential but does not apply to surgical cases coming through the emergency room or to existing hospitalized patients. Further, the mandate notes that the terms “non-urgent or elective” are not specifically defined and recommends that hospitals create a physician task force to be available to make determinations on a case-by-case basis.
Elective Procedures Update. Gov. Mike Dunleavy issued Health Mandate 15 on April 15, providing that procedures that require minimal protective equipment may resume on April 20 if providers continue to follow guidance regarding the provision of telehealth whenever possible, maintain physical barriers, require masks for all patients, screen all patients for COVID-19 symptoms, minimize aerosolizing procedures, and test all patients for COVID-19 if they have an emergent or urgent need for a procedure.
Providers may continue to provide urgent or emergent procedures but also must follow the enhanced screening and safety measures noted above. Therefore, surgeries are allowed to proceed if a delay would cause a significant impact to the health, livelihood or quality of life of a patient. All patients undergoing such procedures should be tested for COVID-19 within 48 hours of the procedure and the procedure delayed, if possible, for any positive results.
The health mandate also provides that non-emergent surgeries and procedures, defined as those that cannot be postponed beyond eight weeks without posing a significant risk to quality of life, may resume on May 4, if the following conditions have been met:
- Healthcare delivery can meet all of the standards outlined in the mandate.
- Healthcare is delivered by a provider listed in the statute.
- Healthcare can be safely done with a surgical mask, eye protection and gloves.
- If the procedure puts the healthcare worker at increased risk — such as deliveries, dental work or aerosolizing procedures such as suctioning, intubation or breathing treatments — then a negative test for COVID-19 must be obtained within 48 hours prior to the procedure.
- There may be no visitors in healthcare facilities except for end-of-life visits, a parent of a minor, and a support person for labor and delivery settings. Only one spouse or caregiver who resides with the patient will be allowed into the facility during the day of a surgery or procedure and at the time of patient discharge to allow for minimal additional exposure. If a caregiver does not reside with the patient, the caregiver can be with the patient at the time of discharge. Any of the allowed visitors must wear a fabric face covering.
- Workers must maintain social distancing of at least six feet from non-patients and must minimize contact with the patient.
- Exceptional environmental mitigation strategies must be maintained, including the protection of lobbies and front desk staff.
- Unlicensed assistive personnel necessary to procedures under this section may be included in service delivery.
Stay-at-Home. Gov. Doug Ducey issued Executive Order 2020-18, effective March 31 through April 30, 2020, ordering all individuals to limit their time away from their place of residence except for conducting essential activities, employment in essential functions, and to obtain services provided by an essential business. As with other states, the order to limit time away from home does not apply to seeking healthcare services or employment in healthcare.
Stay-at-Home Update. On April 29, Gov. Doug Ducey extended the state’s stay-at-home order through May 15, 2020, but with amendments that allow some businesses to resume operations with modifications. The order still directs all residents to limit their travel except for essential activities (including healthcare), but sets a staggered approach to how businesses previously classified as non-essential may resume operations. As of May 4, non-essential businesses that engage in the sale of goods may operate through delivery services, window services, walk-up services, drive-thru services, curbside delivery, and by appointment, while following requirements for social distancing. As of May 8, 2020, non-essential retailers may operate and offer goods in-store as long as guidelines are followed.
Stay-at-Home Update. On May 4, Gov. Doug Ducey issued an additional, updated executive order, providing that as of May 4, additional businesses such as barbers and cosmetologists may resume operations if they follow guidelines such as requiring appointments and face coverings. Further, as of May 11, dine-in services may resume with limited capacity, social distancing and required sanitation protocols.
Stay-at-Home Update. Gov. Doug Ducey issued an updated executive order, continuing the phased-in approach for reopening segments of the state’s economy and lifting the stay-at-home order on May 15. Under the updated order, all businesses in the state must develop and implement policies based on the Centers for Disease Control and Prevention (CDC), OSHA, Department of Labor and Arizona Department of Health Services (ADHS) guidance to limit the further spread of COVID-19, including social distancing and sanitation procedures. In conjunction with the governor’s order, the ADHS issued additional guidance for certain business sectors and customers, including pools, gyms and fitness centers, and spas.
Stay-at-Home Update. On June 30, in the face of increasing cases of COVID-19 throughout the state, Gov. Doug Ducey issued an executive order rolling back prior reopening of businesses and imposing other restrictions. The order prohibits organized events of more than 50 people and requires the closure of bars, indoor gyms and fitness clubs, movie theaters, and water parks and tubing operators.
Stay-at-Home Update. On July 23, 2020, Gov. Doug Ducey issued an updated executive order extending the governor’s prior order pausing business reopenings to slow the spread of COVID-19. The updated order will stay in place and continue to be reviewed every two weeks. Under the orders, mass gatherings of more than 50 people are prohibited, and the following businesses must continue to pause operations: bars with a series 6 or liquor license, indoor gyms, indoor movie theaters, water parks and tubing operations.
Elective Procedures. Gov. Ducey issued Executive Order 2020-10, effective March 21, 2020, ordering that all non-essential or elective surgeries (including elective dental surgeries) that utilize PPE or ventilators not be performed at any state licensed healthcare facility or by any state licensed healthcare provider. A “non-essential or elective surgery” is defined as “a surgery that can be delayed without undue risk to the current or future health of a patient.” Healthcare providers are to use their best medical judgment to determine whether a procedure is elective or not and in making that decision, must consider the health and age of the patient, especially in light of the COVID-19 infection and effects on recovery and the urgency of the surgery. Further, the order provides that a procedure should not be deemed elective “if it would threaten the patient’s life, threaten permanent dysfunction or impairment of any body part, risk metastasis or progression of staging, or require the patient to remain hospitalized if the surgery was delayed.”
Elective Procedures Update. On April 22, Gov. Ducey issued Executive Order 2020-32 to allow elective surgeries to resume on or after May 1 for those providers that have requested and received an exemption from the Arizona Department of Health Services from the prior executive order requiring the postponement of elective procedures. Providers and facilities must demonstrate that they can meet minimum criteria that includes the following:
- A continuing supply of PPE that will support the hospital, healthcare facility or provider for more than 14 days and that is not reliant on the state or a county health department
- Adequate staffing and bed availability with no greater than 80 percent of total bed capacity occupied, if it is a hospital
- Implementation of a robust COVID-19 testing plan to test all at-risk healthcare workers and each patient prior to the scheduling of an elective, non-essential surgery or during the pre-operative time period
- Implementation of a process to identify, inventory and document the availability of PPE, test collection kits and a lab that can run the COVID-19 diagnostic test
- Implementation of a universal symptom screening process for all staff, patients and visitors prior to entry into the facility
- Implementation of an enhanced cleaning process for patient and waiting areas
- Implementation of policies and procedures for appropriate discharge planning for patients, including pre-discharge diagnostic COVID-19 testing for patients transferring to a nursing care institution, residential care institution setting or group home for the developmentally disabled
- Implementation of policies and procedures that prioritize elective, non-essential surgeries based upon urgency following the Centers for Medicare & Medicaid Services’ adult elective surgery and procedures recommendations
Further, any hospital, facility or provider that obtains such an exemption from the prior prohibition will not be eligible to request or receive PPE from the state or county health departments.
Elective Procedures Updates. As the number of COVID-19 cases in Arizona continues to rise and the Arizona Department of Health noted that hospital bed capacity was at 83 percent (under Executive Order 2020-32, elective procedures must cease if capacity exceeded 80 percent) the Arizona Department of Health issued a letter directing hospitals to fully activate their emergency plans. Further, the letter directed hospitals to be judicious and reduce or suspend elective procedures to ensure sufficient hospital bed capacity for both COVID-19 and non-COVID-19-related care. Facilities that had resumed elective procedures but are now affected by staff shortages or insufficient bed capacity must suspend elective surgeries immediately.
Stay-at-Home. Arkansas does not yet appear to have issued a stay-at-home order.
Stay-at-Home Update. While Arkansas did not have a specific stay-at-home order in place, Gov. Asa Hutchinson released an executive order on May 5 providing that all businesses must adhere to social distancing guidelines, schools must remain closed, restaurants may resume dine-in services as of May 11 and gyms may resume operations as of May 4. Further, barbers, salons and medical spas may resume operations as of May 6.
State-at-Home Update. On June 12, 2020, Gov. Asa Hutchinson announced that the state would move into phase two on June 15, 2020, even though the state had announced its largest single-day jump in cases the same week. Phase two includes a series of industry-specific directives on reopening such as general business limitations on social distancing and sanitation. Dine-in seating for restaurants may continue and increase patronage to 66 percent of capacity.
Stay-at-Home Update. Arkansas entered phase 2 of its reopening plan on June 15, which allowed for increased capacity at businesses. In addition, the state has issued industry-specific guidelines for operation.
Stay-at-Home Update. Effective July 20, 2020, the Arkansas Department of Health issued a face covering directive requiring individuals to wear face coverings in all non-residential indoor settings with non-household members where social distancing cannot be maintained, and in outdoor settings with non-household members where social distancing cannot be maintained.
Elective Procedures. On April 3, 2020, the Arkansas Department of Health issued a Directive on Elective Procedures stating that all procedures that can be safely postponed shall be rescheduled. The order notes that this requirement applies to all procedures, testing and office visits that can be safely postponed. Further, routine dental and eye care visits must also be postponed. While the directive does not apply to small rural hospitals with less than 60 beds or critical hospitals, such hospitals are strongly urged to follow the directive. Emergent and urgent care are considered an exception to the requirement to postpone procedures and treatment, and the directive provides that exceptions should be made in the following circumstances:
- There is a threat to the patient’s life if the procedure is not performed.
- There is a threat of permanent dysfunction of an extremity or organ system if the surgery is not done.
- There is a risk of metastasis or progression of staging of a disease or condition if the surgery is not performed.
- There is a risk that the patient’s condition will rapidly deteriorate if the surgery is not done, and there is a threat to life or an extremity or organ system or a threat of permanent dysfunction or disability.
Elective Procedures Update. Gov. Asa Hutchinson announced that elective procedures may resume in Arkansas beginning April 27, and the Arkansas Department of Health is working to finalize requirements regarding how elective procedures may proceed.
Elective Procedures Update. The Arkansas Department of Health issued a directive on resuming elective procedures, effective April 27, listing requirements for the resumption of these procedures. The directive notes that all facilities must understand their capabilities when determining whether to proceed with elective procedures, such as available beds, testing ability, workforce, supply chain, etc. Elective procedures are specifically limited as follows:
- Only outpatients with no plans for overnight stay.
- An American Society of Anesthesiologists rating of I or II.
- For those with a II rating, their disease process should be well-controlled.
- No contact with known COVID-19 patients during the preceding 14 days.
- Patients must be asymptomatic for COVID-19 per ADH guidelines.
- Start with a small initial volume of cases and increase incrementally as PPE availability and number of statewide occurrences dictate.
- Each institution must have an ample supply of PPE for resuming elective procedures while maintaining a reserve in case there is a resurgence of the virus. The acquisition of PPE is a matter for each institution to address and is not the responsibility of ADH.
- For an asymptomatic patient to be a candidate for a procedure, he/she must have at least one negative COVID-19 NAAT test within 48 hours prior to the beginning of the procedure.
These requirements apply to all elective procedures, including dental, eye, nasopharyngeal, chest surgery and colonoscopy.
Elective Procedures Update. Under the phase two guidelines, elective dental procedures may resume on June 15, 2020, if providers adhere to Arizona Department of Health guidelines such as patient screenings, use of adequate PPE, pre-procedural mouth rinsing and increased sanitation procedures.
Elective Procedures Update. On Aug. 1, 2020, the Arkansas Department of Health issued an additional directive on resuming elective procedures in phase four of the state’s reopening. The directive rescinds the prior requirement for a patient to have a negative COVID-19 test prior to an elective procedure but still strongly encourages that providers obtain such a negative result.
Stay-at-Home. Effective from March 19, 2020, Gov. Gavin Newsom issued California Executive Order N-33-20, directing that all individuals stay at home except as needed to maintain critical infrastructure sectors. Such critical infrastructure sectors include healthcare and public health which is defined broadly as healthcare facilities, research centers, suppliers, manufacturers, and other physical assets and vast, complex public-private information technology systems required for care delivery and to support the rapid, secure transmission and storage of large amounts of healthcare data. Essential workforce members therefore include healthcare providers and caregivers.
Stay-at-Home Update. Gov. Newsom announced an update to California’s pandemic response roadmap outlining criteria and benchmarks the state will need to reach to modify the stay-at-home order. As with the federal government and other states, California’s plan will be completed in stages depending upon the facts on the ground.
Stay-at-Home Update. On May 8, California moved to stage two of its roadmap to reopening the state. The stage two guidance provides specific guidelines for reopening based on industry type, such as agriculture, childcare, manufacturing, lodging and dining. Curbside retail may reopen now during stage two, and additional retail, office and dine-in restaurants are expected to be able to open later during this stage. To reopen, when allowed by the state, each business must do the following:
- Perform a detailed risk assessment and implement a site-specific protection plan.
- Train employees on how to limit the spread of COVID-19, including how to screen themselves for symptoms and stay home if they have them.
- Implement individual control measures and screenings.
- Implement disinfecting protocols.
- Implement physical distancing guidelines.
Stay-at-Home Update. Responding to recent increases in cases of COVID-19, Gov. Gavin Newsom and the California Department of Public Health issued an order on July 1 requiring the closure of indoor operations for certain business sectors in 19 counties for three weeks. The affected sectors include dine-in restaurants, wineries and tasting rooms, movie theaters, family entertainment centers, zoos and museums, and cardrooms.
Stay-at-Home Update. On July 13, 2020, the California Department of Public Health issued an order expanding the restrictions on business openings statewide due to continued increases in COVID-19 cases. Bars, brewpubs, breweries and wineries are ordered closed across the state unless they meet an exception such as offering outdoor sit-down, dine-in meals. Dine-in restaurants must close all indoor seating. Indoor attractions at zoos and museums must also close. Further, counties on the current County Monitoring List that have been on the list for three consecutive days must close all indoor operations for gyms and fitness centers, places of worship, protests, offices of non-critical infrastructure, personal care services, hair salons and barbershops, and malls.
Stay-at-Home Update. California has moved to a Blueprint for a Safer Economy, which tracks a number of health-related statistics at the individual county level and places each county into one of four tiers. Businesses have certain restrictions on their operations, depending upon the tier assigned to their individual locality. For example, if a locality is in the widespread tier, retail business may only operate at 25 percent of capacity.
Elective Procedures. The March 19 Executive Order also provides that the healthcare delivery system shall prioritize services to those who are sickest and shall prioritize resources, including PPE, for the providers providing direct care. While the order does not prohibit elective procedures, and California does not yet appear to have issued a specific order regarding elective procedures, the California Department of Public Health has noted on under Frequently Asked Questions that “non-essential medical care like eye exams, teeth cleaning, and elective procedures must/should be canceled or rescheduled. If possible, health care visits should be done remotely.” California does not yet appear to have issued any more formal guidance on criteria to consider whether a procedure is non-essential, but, as noted, the situation is rapidly changing.
Elective Procedures Update. Gov. Newsom issued an announcement on April 22 to allow for the resumption of medical care delayed under the state’s prior executive orders. The governor’s announcement notes that medical procedures — such as heart valve replacements, angioplasty and tumor removals — and key preventive care services, such as colonoscopies, that had been delayed will be able to resume. Further, California will work with the states of Washington and Oregon as part of the Western States Pact to share best practices for providers to resume such care in areas that have enough hospital capacity.
Elective Procedures Update. On April 26, the California Department of Public Health issued an announcement regarding the resumption of deferred and preventative healthcare. The announcement notes that it is focusing on resuming elective and non-urgent procedures at hospitals, outpatient care including primary care and specialty care in physician offices and health centers, behavioral health, long-term care, and ancillary, pharmacy and dental services. The department continues to urge that providers maximize telehealth whenever its use is appropriate based on the patient and condition. The department provides a number of considerations for resuming services:
- Prevalence of COVID-19
- Stock of PPE and other medical equipment and supplies
- Availability of testing
- Availability of staff
- Policies and procedures to provide infection control
- Screening of staff
- Social distancing requirements
- Face coverings for all patients
- Limiting the number of patients in waiting areas
The guidelines also provide factors to consider specific to settings such as hospitals, outpatient surgery and skilled nursing facilities.
Stay-at-Home. Gov. Jared Polis issued Amended Public Health Order 20-24, effective March 26, 2020, and updated on April 9 to extend the timeframe of the order through April 26, 2020. It requires individuals to stay at home and only travel for necessary activities or travel to and from work to operate critical businesses. Under the order, travel to receive healthcare services is a necessary activity. Further, travel to and from work to support healthcare operations, which is defined broadly to include hospitals, medical care, research laboratories, home health, pharmaceutical companies, pharmacies and behavioral health, is allowed.
Stay-at-Home Update. Gov. Jared Polis provided an update to the Colorado stay-at-home order, noting that it will be allowed to expire on April 26 and the state will move to a “Safer at Home Phase” beginning April 27. During this phase, residents will no longer be ordered to stay at home, but will be strongly encouraged to do so. Additionally, vulnerable populations must continue to stay at home unless leaving for essential activities. Retail businesses and 50 percent of offices will be able to open for curbside delivery but both will be required to maintain social distancing guidelines.
Stay-at-Home Update. Effective May 27, Gov. Jared Polis issued updated guidance for the reopening of restaurants, summer camps and private camping in the state. Indoor dining could resume at 50 percent capacity with a maximum of 50 patrons. Face coverings are encouraged, social distancing must be adhered to, and restaurants must put in place enhanced sanitation requirements.
Stay-at-Home Update. While Colorado is still in level two of its safer-at-home plan, the state issued updated sector-specific guidance, including for healthcare settings. These guidelines contain standard requirements promoting telehealth, sanitation and distancing requirements.
Stay-at-Home Update. Gov. Jared Polis issued an updated executive order on June 30, extending the state’s public emergency for 30 additional days while also ordering the closure of inside bar service (while still allowing the sale of to-go beverages).
Stay-at-Home Update. On July 23, 2020, Gov. Jared Polis issued an amended executive order, extending certain actions of prior orders and requiring that all bars and other similar establishments cease alcohol sales for on-premises consumption between 10 p.m. and 7 a.m. each day.
Elective Procedures. Gov. Polis issued Executive Order D 2020 009, effective March 23, 2020 through April 14, 2020, ordering that all hospitals and outpatient surgery and procedure providers cease all elective and non-essential surgeries and procedures. The order also directs all such providers to preserve PPE, ventilators, and respirators. Rural and critical access hospitals are exempted from the order, but are strongly advised to follow its directives. The order applies to all dental, medical, and veterinary “voluntary or elective procedures,” which is defined as surgeries or procedures that “can be delayed for a minimum of three months without undue risk to the current or future health of the patient as determined by the guidelines developed by the hospital, surgical center or other treating medical facility.” The order also notes that surgeries and procedures can continue for the following:
- There is a threat to the patient’s life if the surgery or procedure is not performed;
- There is a threat of permanent dysfunction of an extremity or organ system if the surgery or procedure is not performed;
- There is a risk of metastasis or progression of staging of a disease or condition if the surgery or procedure is not performed; or
- There is a risk that the patient’s condition will rapidly deteriorate if the surgery or procedure is not performed and there is a threat to life, or to an extremity or organ system, or of permanent dysfunction or disability.
Further, the order provides that only essential personnel for a surgery or procedure shall be in the procedure room where PPE is required in order to preserve PPE. Hospitals and ASCs are also ordered to develop guidelines based on the above principles and must include a process for consultation with the treating provider regarding designating procedures as elective or non-essential.
Elective Procedures Update. Gov. Polis’ update and transition to a “Safer at Home Phase” will allow elective medical and dental procedures to resume but with strict precautions that must ensure adequate PPE is maintained and that the healthcare system has the ability to meet critical needs.
Elective Procedures Update. Gov. Jared Polis issued an expanded executive order, effective through May 27, 2020, detailing specific requirements for the performance of an elective procedure, defined as follows: “a voluntary or elective surgery or procedure means that the surgery or procedure can be delayed for a minimum of three months without undue risk to the current or future health of the patient as determined by the guidelines developed by the Facility ….” Each facility performing elective procedures must develop a plan to reduce or stop such procedures if there is a surge in COVID-19 infections, ensure adequate access to PPE and other medical supplies, develop a plan for intermittent scheduling and increased sanitation, screen patients and staff, and require social distancing, among other requirements.
Elective Procedures Update. Gov. Jared Polis issued an updated executive order effective May 26, 2020, extending the governor’s prior executive order for 30 additional days, allowing elective procedures if providers meet the requirements specified in the prior executive order.
Elective Procedures Update. Gov. Polis issued an updated executive order, effective for an additional 30 days from June 24, extending the prior executive order allowing elective procedures if providers meet the requirements specified in the prior executive order.
Elective Procedures Update. Gov. Polis issued an updated executive order on July 23, 2020, extending the governor’s prior orders for an additional 30 days allowing for elective procedures under certain conditions.
Elective Procedures Update. Gov. Jared Polis issued an executive order on Aug. 21, 2020, extending the governor’s prior order for 30 additional days, allowing elective procedures to continue under specified conditions.
Stay-at-Home. Gov. Ned Lamont issued Executive Order No. 7H, effective as of March 23, 2020 through April 22, 2020, directing all non-essential functions in Connecticut to suspend in-person operations. Essential businesses and functions include essential healthcare operations such as hospitals, clinics, dentists, pharmacies, elder care and home health care workers, companies and institutions involved in the research and development, manufacture, distribution, warehousing, and supplying of pharmaceuticals, biotechnology therapies, health care data, consumer health products, medical devices, diagnostics, equipment, services and any other healthcare related supplies or services.
Stay-at-Home Update. Gov. Ned Lamont issued Executive Order No. 7X, extending the state’s stay-at-home order from April 22 through May 20. Gov. Lamont has advised that his government will be working on a tri-state approach to reopen the region along with New York and New Jersey.
Stay-at-Home Update. While the state’s stay-at-home order is in effect at least through May 20, 2020, the state has issued business sector rules and certification requirements for a May 20 reopening that provide guidance specific to different business sectors, such as hair salons, museums and zoos, offices, restaurants, and retail and mall outlets. Further, such businesses must self-certify that they are following industry-specific guidelines to keep employees and customers safe.
Stay-at-Home Update. Gov. Ned Lamont issued an updated executive order moving the state into phase one of its reopening on May 20. Under the reopening order, restaurants could offer outdoor dining only, offices could reopen, retail stores and malls could reopen, museums and zoos could begin operations, and outdoor recreational activities could resume. Along with the governor’s order, the Department of Economic and Community Development issued several sector rules applicable to different business sectors that must be followed.
Stay-at-Home Update. Gov. Ned Lamont issued additional business-specific guidance for moving the state into phase two of its reopening on June 17, 2020. The guidance includes requirements for amusement parks, hotels, indoor dining, indoor museums, movie theaters, libraries, outdoor entertainment venues, personal care services and sports and fitness centers. The rules continue to address social distancing, capacity, sanitation, personal protective equipment and face coverings.
Stay-at-Home Update. Along with the governors of New York and New Jersey, Gov. Lamont issued a joint incoming travel advisory that any individuals coming into the three states from any states with significant community spread of COVID-19 must self-quarantine for 14 days. The self-quarantine requirement is in effect from June 24, and applies to any person arriving from a state with a positive test rate higher than 10 per 100,000 residents or a state with a 10 percent or higher positivity rate over a seven-day rolling average.
Stay-at-Home Update. During a press briefing on July 6, Gov. Ned Lamont announced that plans to move the state into phase 3 of its reopening plan would be on hold indefinitely.
Stay-at-Home Update. Connecticut moved into phase three of its reopening on Oct. 8. The economy is generally open under phase three, but there are capacity restrictions in place, such as 50 percent or capped at 100 people for indoor events (such as weddings and other gatherings). Restaurants are capped at 75 percent of capacity, and all businesses must maintain social distancing.
Elective Procedures. Connecticut does not appear to have issued a specific order addressing prohibitions on elective procedures.
Stay-at-Home. Effective March 24, 2020, Gov. John Carney of Delaware issued the fifth modification to the Delaware State of Emergency order, which was issued on March 12, 2020. Similar to other states, the Delaware order prohibits residents from leaving their current residences, unless it is for an essential activity. Essential activities include the provision of healthcare services.
Stay-at-Home Update. On May 8, Gov. John Carney extended the state’s stay-at-home order until May 31, 2020. The governor also announced a framework for a phased reopening of the economy that he hopes will begin on June 1, 2020.
Stay-at-Home Update. On June 2, 2020, Gov. John Carney announced that Delaware would move to phase two of the state’s reopening on June 15, 2020. During phase two, businesses may allow for indoor customer services with reduced occupancy, social distancing and increased sanitation requirements. Phase two provides industry-specific guidelines as well, including for museums, food and drink, retail, personal care services, lodging and child care.
Stay-at-Home Update. On June 25, Gov. Carney announced a delay in the state moving to phase 3 of its reopening plan, which was scheduled for June 29. The governor noted the state will make a decision on moving into phase 3 in the next week.
Elective Procedures. Delaware does not appear to have issued an order regarding elective procedures.
District of Columbia
Stay-at-Home. On March 30, 2020, the mayor of the District of Columbia issued a stay-at-home order instructing all D.C. residents to shelter in their place of residence. D.C. residents may leave their residence only to engage in certain essential activities, such as obtaining or working to provide healthcare services.
Stay-at-Home Update. Mayor Muriel Bowser extended the District of Columbia’s stay-at-home order through May 15, 2020. Besides extending the timeframe for the stay-at-home order, the mayor also issued safety protocols including requiring face masks for certain businesses — such as hotels, taxis and other private transportation, and workers and customers of food sellers — and strongly encouraging their use for individuals using public transit.
Stay-at-Home Update. Mayor Muriel Bowser issued an updated order on May 13, extending the District’s stay-at-home order and other public health emergency requirements (such as social distancing and wearing masks) through June 8.
Stay-at-Home Update. The District of Columbia lifted its stay-at-home order on May 29, 2020, and moved into phase one, allowing the reopening of businesses with certain restrictions, and lifting restrictions requiring individuals to say in their residences. Under phase one, individuals are required to wear masks when in public, maintain social distancing and not gather in groups of more than 10. Non-essential retail businesses may reopen, but only for outdoor pickup of items or delivery. Restaurants may open for outdoor dining only (in addition to the takeout and delivery services that previously were allowed).
Stay-at-Home Update. The District of Columbia moved into phase 2 of its reopening on June 22. Under phase 2, gatherings of up to 50 people are allowed, retail businesses may operate at 50 percent capacity, bars and nightclubs remain closed, museums and zoos may open with limitations of 50 people at any indoor auditorium, restaurants may open for indoor dining at 50 percent capacity, and healthcare providers may continue to operate under guidance from the Department of Health to prevent an undue burden on hospital capacity.
Elective Procedures. While not an outright ban, the District of Columbia Department of Health issued Recommendations on Limitations of Elective and Non-Urgent Medical and Dental Procedures on March 17, 2020. The Department of Health recommends the postponement of all elective medical procedures, non-urgent hospital and outpatient visits, and non-urgent dental procedures if the delay will not cause harm.
Elective Procedures Update. As part of the district’s phase one reopening, healthcare providers may resume offering services, including outpatient or other surgical procedures, that will not unduly burden hospital capacity or resources necessary to address COVID-19. Providers must adhere to the D.C. Department of Health’s phase one guidance for elective surgery. The guidance notes that providers should prioritize elective procedures that are essential, based on the urgency for care and need for in-person medical care. Outpatient and short-term stay procedures with a low impact on resources may begin under the updated guidance. Patients must be assessed for symptoms of COVID-19 prior to treatment. Facilities must update policies and procedures to provide for increased sanitation protocols and social distancing. Staff should also be monitored to protect against possible COVID-19 transmission.
Elective Procedures Update. The District issued updated phase 2 guidelines regarding elective procedures providing that all ambulatory surgery centers and hospitals may perform all procedures that can safely be performed from a clinical and environmental perspective. Facilities must continue to screen for COVID-19, ensure social distancing and utilize enhanced sanitation procedures.
Stay-at-Home. Florida Gov. Ron DeSantis issued Executive Order 20-91 requiring all Florida residents to remain in their place of residence. Effective 12:01 a.m. on April 3 through April 30, 2020, the order requires all individuals in Florida to restrict their movements and personal interactions outside their homes to obtaining essential services or conducting essential activities. Essential services encompasses healthcare services, including but not limited to clinical research and development needed for the COVID-19 response, mental and physical health, and pet care.
Stay-at-Home Update. On April 29, Gov. Ron DeSantis issued an updated executive order that is phase one of the governor’s step-by-step approach to reopening the state. On May 4, a number of businesses closed under prior executive orders, such as retail businesses and restaurants, were allowed to begin on-site operations but must adhere to lower occupancy and social distancing requirements. Gyms and fitness centers must remain closed. This phase of the governor’s order is set to last until the governor issues an updated order. Finally, the order allowing for limited reopening of businesses does not currently apply in the counties of Miami-Dade, Broward and Palm Beach, which are still under the governor’s stay-at-home orders restricting non-essential business functions.
Stay-at-Home Update. On May 15, Gov. Ron DeSantis issued an updated and expanded executive order regarding phase one of the state’s plan for recovery. The order contains updated guidance for reopening operations by certain business sectors — such as restaurants, retail, museums and gyms — that limits occupancy to 50 percent and requires social distancing and sanitation. The updated order also provides that professional sports venues may open for training, competitions, events and games. Amusement parks may submit a reopening plan to the state.
Stay-at-Home Update. Effective June 5, 2020, Gov. Ron DeSantis issued an updated executive order moving Florida into phase two of its reopening, except for Miami-Dade, Broward and Palm Beach counties. Under phase two, restaurants, bars and entertainment venues (such as movie theaters, concert venues, playhouses and auditoriums) may operate at 50 percent capacity.
Stay-at-Home Update. At a press conference on June 25, Gov. DeSantis announced the state is not ready to move into phase 3 of reopening due to its spike in positive COVID-19 cases.
Stay-at-Home Update. On Sept. 25, Gov. Ron DeSantis issued an executive order moving the state into phase three of its reopening, essentially lifting all state restrictions.
Elective Procedures. Gov. DeSantis issued Executive Order No. 20-72, effective March 20, 2020, prohibiting all hospitals, ASCs, office surgery centers, dental, orthodontic and endodontic offices, and other health care practitioners’ offices “from providing any medically unnecessary, non-urgent or non-emergency procedure or surgery which, if delayed, does not place a patient’s immediate health, safety, or well-being at risk, or will, if delayed, not contribute to the worsening of a serious or life-threatening medical condition.” The order also states that, as noted in the CMS recommendations, examples of procedures to delay include some endoscopy, most cataract and lens surgeries, non-urgent spine and orthopedic procedures, and cosmetic procedures. Further, the directive also cites the CMS examples of permissible procedures that can be performed, such as removal of a cancerous tumors, transplants, limb-threatening vascular surgeries, trauma-related procedures, and dental care related to the relief of pain and management of infection.
Elective Procedures Update. As part of phase one of the governor’s executive order reopening the state, elective medical procedures may resume as of May 4. Specifically, hospitals, ASCs, office surgery centers, dental and orthodontic offices, endodontic offices and other healthcare practitioners’ offices may perform elective procedures if they meet all of the order’s requirements. These requirements include capacity to immediately treat COVID-19 patients in a surge, and adequate PPE on hand to accommodate such procedures and to treat COVID-19 patients without federal or state assistance. Also, the facility must not have refused to provide support and proactively engage with skilled nursing facilities, assisted living facilities and other long-term care providers.
Stay-at-Home. On April 1, 2020, Gov. Brian P. Kemp provided a media update regarding a Georgia stay-at-home order, initially effective April 3 through April 13, 2020. Gov. Kemp provided an additional media update on April 8, extending the order to require Georgia residents to remain at home. It provides guidance on essential services that will be allowed under the order.
Stay-at-Home Update. Gov. Brian Kemp announced that Georgia is on track to meet the Phase 1 gating criteria to reopen business recommended by the Trump administration. Therefore, the governor announced plans to incrementally reopen sectors of Georgia’s economy. First, Georgia will allow gyms, fitness centers, bowling alleys, body art studios, barbers, cosmetologists, hair designers, nail care artists, estheticians, their respective schools, and massage therapists to reopen starting April 24. These businesses must still meet restrictions such as minimal basis operations (including screening workers for fever and respiratory illness, enhancing workplace sanitation, wearing masks and gloves if appropriate, separating workspaces by at least six feet, teleworking where possible and implementing staggered shifts), as well as maintaining social distancing and regular sanitation. Further, subject to meeting social distancing and sanitation mandates, theaters, private social clubs and restaurant dine-in services will be allowed to reopen April 27. Bars, nightclubs, operators of amusement park rides, and live performance venues are to remain closed.
Stay-at-Home Update. Gov. Brian Kemp issued an updated executive order on May 12, in effect through May 31, 2020, loosening restrictions on certain businesses, such as restaurants, while continuing to require other sectors to remain closed, such as bars, nightclubs and amusement parks. Restaurants may allow additional customers of up to 10 people per 300 square feet of public space.
Stay-at-Home Update. Gov. Brian Kemp issued an updated executive order, effective May 28, 2020, providing updated guidance for the continued reopening of Georgia businesses, with specific guidance for overnight summer camps and summer schools, and rules for reopening businesses. For example, restaurants may operate with no more than 10 patrons per 300 square feet of space, as long as they require social distancing between customers, follow increased sanitation protocols and screen employees for COVID-19. All in-person performance venues must still remain closed. Healthcare providers must continue to abide by the critical infrastructure requirements, which include screening workforce members and patients for COVID-19, enhanced sanitation protocols and social distancing. Dental providers must adhere to the American Dental Association’s Interim Guidance for Minimizing Risk of COVID-19 Transmission and Interim Mask and Face Shield Guidelines. Optometrists must comply with the American Optometric Association’s Practice Reactivation Preparedness Guide and the Georgia Optometric Association’s COVID-19 guidelines. Ambulatory surgery centers must adhere to additional measures, such as screening patients, continuing use of personal protective equipment, social distancing requirements, increased sanitation protocols, and a policy of prioritizing patients with increased risks.
Stay-at-Home Update. Gov. Brian Kemp issue two executive orders on June 29, extending the state’s public health emergency and pausing the state’s reopening plan until Aug. 11, and issuing guidance to business sectors on operations.
Stay-at-Home Update. Gov. Brian Kemp issued an updated executive order continuing requirements on business operations within the state. Businesses must comply with guidance governing their individual business sectors to continue operations.
Elective Procedures. Gov. Kemp’s announcement to incrementally reopen the state’s economy also noted that healthcare providers had voluntarily postponed elective procedures but that, given changes in the COVID-19 situation in the state, he believed Georgia was positioned to obtain the necessary PPE and medical supplies to resume elective procedures.
Stay-at-Home. Effective March 25, 2020, through April 30, 3030, Gov. David Y. Ige issued the Third Supplementary Proclamation for COVID-19. As with other states, the order prohibits individuals from leaving their homes, unless it is for an essential activity. Essential activities include healthcare services. The Hawaii order also requires essential businesses to exercise certain requirements, such as having separate operating hours for elderly and high-risk customers and posting online whether a facility is open and how to reach the facility and continue services by phone.
Stay-at-Home Update. Gov. Ige issued a sixth supplementary proclamation on April 25, extending the stay-at-home order until May 31.
Stay-at-Home Update. Gov. David Ige issued an updated proclamation allowing the first set of businesses to reopen May 7, including:
- Agriculture (non-food), such as landscape, ornamental plant growers and nurseries
- Auto dealerships
- Car washes
- Childcare services, licensed or authorized under the law
- Pet grooming services
- Observatories and support facilities
- Retail and repair services, such as apparel, florists, and watch and surfboard repair (Note: retail does not reopen in the city and county of Honolulu until May 15, and retail and most repair will not reopen in Maui County.)
- Shopping malls — limited to retail and repair services (Note: shopping malls are not reopening in Maui County.)
The proclamation also includes industry-specific guidelines for operations.
Stay-at-Home Update. Hawaii moved into phase two of the state’s reopening plan at the end of May, which is expected to last sometime through June. Under phase two, indoor businesses such as restaurants, exercise facilities, museums, theaters and personal care services may reopen with certain restrictions and requirements, such as increased sanitation, face masks and social distancing.
Stay-at-Home Update. Gov. Ige announced a new pre-travel testing program regarding the state’s requirement that travelers into the state self-quarantine for 14 days. Travelers from out-of-state must obtain a negative COVID-19 test within 72 hours of their arrival and show proof of such a negative result to be able to avoid the state’s 14-day quarantine requirement.
Elective Procedures. Gov. Ige previously issued Executive Order 20-25 ordering all healthcare facilities and providers to render assistance in support of the state’s response to the COVID-19 pandemic. The term “render assistance” includes canceling or postponing elective surgeries and procedures as each facility determines appropriate under the circumstances. The governor’s sixth supplementary proclamation restates the prior elective procedure executive order, which includes canceling or postponing elective surgeries; however, media reports indicate the governor may relax elective procedure prohibitions.
Stay-at-Home. On March 25, 2020, Gov. Brad Little issued an emergency proclamation in conjunction with an order issued by the director of the Department of Health imposing a statewide stay-at-home order for all Idaho residents. Under the stay-at-home order, Idaho residents are required to stay at their residences, unless seeking essential services. This includes the provision and business of healthcare.
Stay-at-Home Update. On April 25, and with the state’s stay-at-home order set to expire, Gov. Little announced a four-stage guideline for opening Idaho. The first stage takes effect May 1, allowing most retail business to open with certain parameters in place, such as social distancing and sanitation. The state will progress to the next stage only upon meeting specified criteria monitoring decreases or increases in COVID-19 cases.
Stay-at-Home Update. Gov. Brad Little issued a stay healthy order on May 16, providing that businesses except for those specified in the order may continue operations. Those that must stay closed include bars and nightclubs and large venues, such as movie theaters, concert venues, sporting venues and public pools. Businesses and individuals must continue to adhere to social distancing and sanitation requirements.
Stay-at-Home Update. Idaho moved into stage four of its reopening plan on June 13, 2020, which is expected to last until June 26, 2020. All businesses may continue operations in compliance with requirements, gatherings of any size may take place with social distancing, and non-essential travel may resume. Stage four information also includes industry-specific guidance.
Stay-at-Home Update. Gov. Brad Little announced that the state will stay in phase 4 at least until July 10, when the state was expected to move into phase 5 at the end of June.
Elective Procedures. Idaho does not yet appear to have issued an order regarding elective procedures.
Stay-at-Home. Effective March 21 at 5 p.m. through April 7, 2020, Gov. J. B. Pritzker issued a stay-at-home order (COVID-19 Executive Order No. 8) in response to the spread of COVID-19 in Illinois. On April 1, 2020, Gov. Pritzker issued an updated COVID-19 Executive Order No. 16, extending the stay-at-home directive through April 30. Healthcare and public health operations listed in the Illinois order include examples such as biotechnology companies, medical cannabis dispensaries, reproductive health care providers, mental and substance abuse providers, and generally healthcare facilities, providers, and suppliers of healthcare services.
Stay-at-Home Update. Gov. Pritzker announced a modified stay-at-home order on April 23, extending the order through May 30, 2020. The order also provides that state parks will begin a phased reopening and reclassifies certain businesses — such as greenhouses, garden centers and nurseries — as essential businesses that may reopen. Further, non-essential retail businesses may reopen to fulfill telephone and online orders for outside pickup or delivery. Finally, the order directs all individuals to wear a face covering or mask when in public where six feet of social distancing cannot be maintained.
Stay-at-Home Update. Gov. J. B. Pritzker released an update to the state’s restore Illinois plan on May 20, providing guidelines for businesses to resume operations when the state’s stay-at-home order expires at the end of May. Under phase three of the plan, businesses could resume operations in compliance with a set of 10 industry-specific guidelines for sectors such as manufacturing, fitness centers, offices, personal care services, day camps, and restaurants and bars.
Stay-at-Home Update. Gov. Pritzker announced that Illinois will move into phase 4 of its reopening plan on June 26. Under phase 4, gatherings of up to 50 people are allowed, indoor recreation such as bowling alleys can operate at 50 percent capacity, indoor dining may resume at 25 percent capacity, museums and zoos may operate at 25 percent capacity, and health and fitness centers may operate at 50 percent capacity.
Stay-at-Home Update. On July 15, 2020, Gov. J. B. Pritzker and the Illinois Department of Public Health announced the state’s new mitigation plan that takes a regional approach to combating potential COVID-19 surges in a region by restricting certain activities if a particular region has a sustained increase in a seven-day rolling average in the positivity rate, hospital admissions or reduction in hospital capacity, or three consecutive days averaging an 8 percent positivity rate or higher. The mitigation plans that would be put into place if such triggers are met are on a sliding scale of three tiers, such as moving from reduced indoor capacity for businesses to suspending indoor services.
Elective Procedures. The Illinois Department of Public Health (IDPH) issued guidance regarding elective surgical procedures, which recommends cancelling all elective surgeries and procedures. Elective is defined as “those procedures that are pre-planned by both the patient and the physician that are advantageous to the patient but are NOT urgent or emergent. Physicians should use their medical judgement to determine the need for surgery.” The IDPH guidance also urges providers to consider other factors to ensure that the adequacy of healthcare providers, supplies, space, considering the spread and potential surge of COVID-19 such as:
- Staffing Considerations
- Continue to account for staffing necessary to perform emergent operations or procedures.
- Canceling elective procedures to free up nurses, doctors, surgeons, and anesthesia providers to provide care for patients when the system becomes overwhelmed.
- Hospitals should set up alternate staffing plans to accommodate the influx of patients.
- Examine utilizing nurse anesthetists, pre-/post-operative nurses, and nurse practitioners to provide alternative levels of care elsewhere.
- Use administrative/clerical staff to possibly set up childcare areas for essential medical staff to continue to work if daycares are closed.
- Hospitals should assess how to provide just in time training to those staff that could fulfill other roles in a patient care/assistive capacity.
- Space Considerations
- The pre-anesthesia and recovery rooms can then be used for patient care.
- Outpatient surgery centers affiliated with hospitals could be used for overflow or redirecting of less sick patients in an alternate treatment area and staff could be used there.
- Supplies/resource considerations
- Canceling procedures will also allow for reallocation of PPE that is used for surgical procedures.
- Beds, stretchers, and linens can be used for inpatient care instead of surgical procedures.
- Ventilators could be reallocated from surgical areas to patient care areas.
Elective Procedures Update. The Illinois Department of Public Health issued updated elective surgery and procedures guidance, providing that, beginning May 11, hospitals and ASCs may begin to perform elective surgeries and procedures if specific criteria are met. The guidance provides criteria based on whether a procedure is inpatient or outpatient, as well as addressing regional and facility criteria. Examples of criteria are COVID-19 prevalence in the area or facility, hospital or facility utilization and capacity, COVID-19 testing for prospective patients, protective equipment and infection control.
Elective Procedures Update. On May 13, Gov. J. B. Pritzker issued an executive order that essentially incorporates the Illinois Department of Public Heath’s prior mandates and requirements for the performance of elective procedures. The order further provides that hospitals and healthcare professionals canceling or postponing elective procedures, as well as those providing elective procedures, shall be immune from civil liability related to the diagnosis, treatment or transmission of COVID-19 if they were providing care consistent with current IDPH guidance.
Stay-at-Home. Indiana Gov. Eric J. Holcomb issued Executive Order No. 8, effective March 24, 2020 through April 6, 2020, ordering that all people stay at home unless engaging in essential activities or essential businesses and operations, which are defined as including travel for health and safety. Gov. Holcomb issued Executive Order 20-18 on April 6, 2020, extending the stay-at-home directive until April 20. The orders also provide that individuals may leave their residences to engage in healthcare and public health operations, which is broadly defined and includes hospitals, clinics, dental offices, pharmacies, public health entities, pharmaceutical and medical device companies, OBGYNs, eye care centers, home health, mental health and substance abuse, veterinary care, amongst others.
Stay-at-Home Update. Gov. Eric Holcomb issued an updated executive order on April 20, extending the stay-at-home order until May 1. Residents may still continue to travel for essential activities, which includes traveling to receive or work in healthcare.
Stay-at-Home Update. On May 1, Gov. Eric Holcomb issued the back on track plan to begin a phased reopening of the state. The plan notes that phase two begins on May 4 for most of the state (excluding the counties of Cass, Lake and Marion until later dates), and allows for the phased reopening of businesses while imposing requirements such as limited capacity and social distancing.
Stay-at-Home Update. Indiana progressed to stage three of its back-on-track plan, effective May 22 through June 13. Under stage three guidelines, social gatherings of up to 100 people are allowed, retail stores and malls may move to 75 percent occupancy, fitness centers may open with restrictions, organized sports may resume with social distancing, and community pools may open according to Centers for Disease Control and Prevention (CDC) guidance. Playgrounds, overnight youth camps, bars and nightclubs, amusement parks, movie theaters and schools remain closed.
Stay-at-Home Update. Indiana moved into stage four of its reopening plan on June 12, 2020, which is expected to last until July 3, 2020. Social gatherings of up to 250 people may now occur, outdoor visitation may take place at assisted living centers and nursing homes, professional work may take place at full capacity, retail stores and malls may open at full capacity, in-door dining may continue but at 75 percent capacity, bar seating may open at 50 percent capacity, and entertainment venues may open at 50 percent capacity.
Stay-at-Home Update. Gov. Eric Holcomb announced that that state would modify its reopening plane to move to phase 4.5 on July 1, expected to last through July 17, rather than move fully into phase 5. Most restrictions stay in place under phase 4.5, but beginning July 4, fairs, festivals and similar outdoor events were allowed to open.
Stay-at-Home Update. Gov. Eric Holcomb issued an updated executive order on July 16, 2020, which provides that the state will continue in stage 4.5 at least until July 31, 2020.
Stay-at-Home Update. On Aug. 26, 2020, Gov. Eric Holcomb issued an updated executive order to extend its stage 4.5 for at least 30 more days.
Stay-at-Home Update. Indiana moved into stage five of its reopening plan on Sept. 26, which requires face coverings in public. Restaurants and bars may open at full capacity but social distancing is required, and indoor venues of all types may operate at full capacity with social distancing.
Elective procedures. Gov. Holcomb’s April 20 executive order also includes provisions addressing emergent and elective procedures. Specifically, the order provides that as long as sufficient PPE, staff, and necessary medical supplies are available to allow for treatment of COVID-19 patients, hospitals should continue to perform “clinically indicated procedures meant to diagnose, screen, or treat medical conditions that have the potential for short-term or long-term morbidity and/or mortality.” Examples include cardiac, vascular, neurologic, cancer, gastrointestinal, respiratory and other procedures meant to alleviate significant pain or symptoms making quality of life unacceptable.
The order also addresses prior restrictions on elective procedures by stating that the state will re-evaluate any such prohibitions for possible modifications that would allow for the resumption of such procedures at 11:59 p.m. on April 26.
Elective Procedures Update. Gov. Holcomb issued Executive Order 20-24 providing that, as of 11:59 p.m. on April 26, healthcare providers and facilities may resume elective procedures as long as they have developed and implemented policies and procedures to protect patients and staff against COVID-19 and have sufficient PPE. Providers are urged to consult any best practices or recommendations developed by medical trade associations.
Stay-at-Home. Although Iowa Gov. Kimberly K. Reynolds has not issued a “stay-at-home” order directly, the Proclamation of Disaster Emergency, signed on April 6, 2020, essentially functions as one. It prohibits all non-essential businesses, such as enclosed malls, playgrounds, campgrounds, restaurants and bars (for dine-in services). Similarly, gatherings of more than 10 people are prohibited. Essential operations, such as healthcare services, are allowed. The disaster proclamation will remain in effect through April 30, 2020.
Stay-at-Home Update. Gov. Reynolds issued an updated proclamation, extending the prior proclamations requiring the closure or limitation on business and travel, but with numerous modifications. The modified proclamation allows that, effective May 1, restaurants, fitness centers, malls, libraries, race tracks and certain other retail establishments may reopen in a limited fashion with public health measures in place in 77 counties. Businesses must adhere to specific criteria, such as reductions in operating capacity, social distancing and sanitation practices.
Stay-at-Home Update. Gov. Kim Reynolds issued an updated proclamation on May 6 allowing the reopening of additional businesses — such as campgrounds, drive-in movie theaters, tanning salons and medical spas — while imposing requirements such as social distancing and increased sanitation procedures. Malls may also reopen as long as they comply with additional protocols such as operating at 50 percent capacity, closing common seating areas and following social distancing and sanitation procedures.
Stay-at-Home Update. Gov. Kim Reynolds issued an updated proclamation on May 20, allowing the reopening of additional businesses in accordance with state guidance. On May 22, movie theaters, museums, zoos and swimming pools could reopen, while adhering to limited occupancy, social distancing and sanitation protocols. The governor also announced that on May 28, bars previously limited to carry-out and delivery will be permitted to offer indoor and outdoor seating.
Stay-at-Home Update. Gov. Kim Reynolds issued an updated proclamation on May 26, 2020, allowing the staggered reopening of additional businesses. Bars, wineries, breweries, distilleries, and social and fraternal clubs may reopen on May 28, 2020, instituting the same public health measures as restaurants. Outdoor performance venues, casinos, bowling alleys, amusement parks, skating rinks, skate parks and playgrounds may open on June 1, 2020. Venues and establishments must continue to adhere to limits of 50 percent capacity.
Stay-at-Home Update. Gov. Kim Reynolds issued an updated proclamation, effective June 12, 2020, that further eases restrictions on businesses and individuals and extends the public health emergency until June 25, 2020. Capacity limits have ended but social distancing requirements must continue to be met.
Stay-at-Home Update. Gov. Kim Reynolds extended the state’s public health emergency proclamation through July 25, keeping in place all prior restrictions and requirements on business operations.
Stay-at Home Update. Gov. Kim Reynolds issued a public health declaration on July 24, 2020, extending the state’s prior declarations until Aug. 23, 2020.
Stay-at-Home Update. On Aug. 21, 2020, Gov. Kim Reynolds issued a new health proclamation extending the public health emergency and restrictions already in place for an additional 30 days.
Elective Procedures. Gov. Reynolds issued a new proclamation, effective March 27, 2020, providing that all non-essential or elective surgeries and procedures that utilize PPE shall not be performed by any hospital, ASC, or outpatient surgery provider. A non-essential or elective procedure is defined as “one that can be delayed without undue risk to the current or future health of a patient.” Providers must consider all appropriate factors, including but not limited to, “(1) threat to the patient’s life if the surgery or procedure is not performed; (2) threat of permanent dysfunction of an extremity or organ system; (3) risk of metastasis or progression of staging; and (4) risk of rapidly worsening to severe symptoms.” Hospitals and ASCs must limit all non-essential individuals in surgeries or procedure rooms and patient care areas where PPE would be required. Further, each hospital and ASC is directed to establish an internal governance structure to ensure this order is carried out under these principles. This order also applies to dentists. On April 9, 2020, the Iowa Department of Public Health issued a PPE Shortage Order, reiterating that the demand for PPE must be immediately decreased and ordering compliance with the ban on nonessential medical and dental services that was issued in the initial proclamation, noted above, and with all subsequent extensions of the proclamation.
Elective Procedures Update. Gov. Reynolds also issued an updated proclamation on April 24, stating that, effective 5 a.m. on April 27, hospitals, outpatient surgery centers and outpatient procedure providers may perform inpatient surgeries and procedures that, if delayed, would pose a significant risk to quality of life. The same providers may also perform outpatient surgeries and procedures if the providers comply with specific requirements such as ensuring adequate supplies of PPE, COVID-19 testing and adequate hospital capacity.
Elective Procedures Update. Gov. Reynolds’ updated proclamation also notes that, as of May 6, dental offices may resume operation if they comply with additional requirements such as following dental board protocols and maintaining adequate PPE without having to rely on state or federal sources.
Stay-at-Home. On March 28, 2020, Gov. Laura Kelly issued Executive Order 20-16, requiring individuals to stay in their homes unless performing an essential activity. Such essential activities where travel is allowed include seeking medical care and going to and from work to perform an essential function. Such essential functions allowing for travel to and from work include providing medical care and services.
Stay-at-Home Update. On April 30, Gov. Laura Kelly issued phase one of the state’s plan to begin reopening businesses and lifting restrictions on travel, effective May 4. The order allows for the resumption of business activities by previously closed businesses as long as they meet social distancing guidelines, cleanliness and sanitation requirements, and avoid gatherings of 10 or more individuals when social distancing cannot be met. Under this order, several types of businesses must remain closed, such as bars and nightclubs (excluding carryout and curbside services), casinos, theaters and museums, fitness centers and gyms, and personal grooming services.
Stay-at-Home Update. On May 14, Gov. Laura Kelly issued an update on the state’s plan for reopening. Highlights of the updated order include the following:
- Continued prohibition on gatherings of 10 or more individuals.
- Nail salons, barber shops, hair salons, tanning salons, tattoo parlors and other personal service businesses where close contact cannot be avoided may open, but only for prescheduled appointments or online check-in.
- Fitness centers and health clubs may open, but in-person group classes may not occur and locker rooms must be closed except as necessary to use restroom facilities.
- In-person commencement or graduation ceremonies may occur with no more than 10 individuals in a room, gymnasium or facility at one time as long as six feet of social distancing is maintained. Outdoor drive-thru graduation ceremonies, during which no more than 10 individuals (e.g., school administration, graduate, family members) are in the same area outside of their vehicles at a time, are allowed.
The following must remain closed:
- Bars and night clubs, excluding curbside and carryout services
- Non-tribal casinos
- Theaters, museums and other indoor leisure spaces (trampoline parks, arcades, etc.)
- Community centers
- Outdoor and indoor large entertainment venues with capacity of 2,000 or more
- Fairs, festivals, carnivals and parades
- Swimming pools (other than backyard pools)
- Organized sports facilities, tournaments, games and practices
- Summer camps
Stay-at-Home Update. Gov. Laura Kelly announced that the state was moving into phase two of the state’s reopening plan on May 22. Under phase two, gatherings of more than 15 people are prohibited, and all businesses except for bars and nightclubs could reopen if they meet guidelines.
Stay-at-Home Update. On June 22, Gov. Kelly announced that Kansas would remain in phase three for at least an additional two weeks when the initial plan was to move into the next phase on June 22.
Stay-at-Home Update. On July 6, Gov. Laura Kelly issued a press release recommending that the state remain in phase 3 of its plan to reopen.
Elective Procedure. Kansas does not yet appear to have issued an order regarding elective procedures.
Stay-at-Home. On March 25, 2020, Kentucky Gov. Andy Beshear issued Executive Order 2020-257. The order requires that only life-sustaining businesses may remain open, which includes healthcare operations. Issued on March 30, 2020, Executive Order 2020-258 prohibits Kentucky residents from traveling to any other state except when required by employment, to obtain certain essential services and for additional operations.
Stay-at-Home Update. On April 29, Gov. Andy Beshear presented an outline for the gradual reopening of businesses and lifting of travel restrictions in Kentucky. Under the outline, the governor presented a tentative schedule for reopening businesses, noting that as of May 11, manufacturing, construction, vehicle and vessel dealerships, professional services (at 50 percent of pre-outbreak capacity), horse racing (without spectators), pet grooming and boarding may reopen. By May 20, 2020, retail businesses and houses of worship may reopen. And, as of May 25, 2020, social gatherings of no more than 10, barbers, salons, cosmetology businesses and similar services may reopen. The governor also noted that certain businesses are not yet ready to reopen, including as restaurants, gyms, movie theaters, campgrounds, youth sports, summer camps, day cares (except for essential healthcare workers) and public pools.
Stay-at-Home Update. On May 7, Gov. Andy Beshear announced the next phase of reopening the state’s economy. Under this second phase, all businesses must follow the state’s 10 rules of staying healthy at work, as well as industry-specific guidance. The updated, tentative dates for reopening sectors of the economy are as follows:
- May 22 – Restaurants, limited to 33 percent capacity and outdoor seating
- June 1 – Movie theaters, fitness centers
- June 11 – Campgrounds, public and private
- June 15 – Child care with reduced capacity, and potentially, low-touch and outdoor youth sports
Stay-at-Home Update. Gov. Andy Beshear updated the state’s healthy-at-work plan setting additional dates upon which certain sectors of the economy could resume operations while continuing to meet guidelines:
- May 25 — personal care services such as barber shops, salons, massage therapy and tattoo parlors
- June 1 — entertainment venues such as