COVID-19: Executive Orders by State on Dental, Medical, and Surgical Procedures

State

Order

Order Text

Date Issued

Date Expiration

Section II effective May 4, 2020. a. Surgeries and intensive procedures are permitted to proceed if delay is deemed to cause significant impact on health, livelihood, or quality of life, if the following conditions are met:

1. Health care delivery can meet all of the standards outline in Section I of this mandate.
2. Health care is delivered by a provider listed in statue (see Section IV).
3. Procedures are prioritized based on whether their continued delay will have an adverse medical outcome.
   1. Each facility should review these procedures with their task force that was created in the April 7, 2020 revision to COVID-19 Health Mandate 005.
   2. Strongly consider the balance of risks vs. benefits for patients in higher risk groups such as those over age 60 and those with compromised immune systems or lung and heart function.
4. Facility must maintain a plan to reduce or stop performing surgeries and procedures permitted by this Section II should a surge or resurgence of COVID-19 cases occur, or a shortage of PPE or testing in their facility or region.
5. The health care can safely done with a surgical mask, eye protection and gloves.
6. Facility has adequate PPE supplies on hand.
7. Capacity at the facility (i.e., bed capacity and healthcare workforce) can accommodate an increase in both COVID-19 hospitalizations and increased post-procedure hospitalizations.
8. Facility has access to adequate testing capacity as required under this mandate.
9. If the procedure puts the health care worker at increased risk with aerosolizing procedures such as surgical suctioning, intubation, or breathing treatments then a negative PCR for SARS-CoV-2 must be obtained within 48 hours prior to the procedure.
10. There are to be no visitors in health care facilities except for: end-of-life visits; a parent of a minor; a support person for labor and delivery settings; and only one (1) spouse or caregiver that 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, they can be with the patient at the time of discharge. Any of the allowed visitors must wear a fabric face covering.
11. Workers must maintain social distancing of at least 6 feet from non-patients and must minimize contact with the patient.
12. Exceptional environmental mitigation strategies must be maintained, including the protection of lobbies and front desk staff.
13. Unlicensed assistive personnel necessary to conduct procedures under this section may be included in service delivery.

Those receiving an exemption from Executive Order 2020-10 may begin these surgeries on or after May 1, 2020. Hospitals, healthcare facilities, and providers (including dental surgery providers) must demonstrate in a request for exemption from Executive Order 2020-10 that shall include:

1. 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; and
2. Adequate staffing and bed availability with no greater than 80% of total bed capacity occupied, if it is a hospital; and
3. 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; and
4. Implementation of a process to identify, inventory and document the availability of PPE, test collection kits, and the availability of a lab that can run the COVID-19 diagnostic test; and
5. Implementation of a universal symptom screening process for all staff, patients, and visitors prior to entry into the facility; and
6. Implementation of an enhanced cleaning process for patient and waiting areas; and
7. Implementation of policies and procedures for appropriate discharge planning of 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; and
8. Implementation of policies and procedures that prioritize elective, non-essential surgeries based upon urgency following the Centers for Medicaid and Medicare Services (CMS) Adult Elective Surgery and Procedures Recommendations.

The Arizona Department of Health Services shall implement a process for hospitals, healthcare facilities and providers to request an exemption from Executive Order 2020-10 and demonstrate they meet the minimum criteria to resume elective, non-essential surgeries. Those receiving an exemption from Executive Order 2020-10 may begin these surgeries on or after May 1, 2020.

A hospital, healthcare facility or provider who has an exemption from Executive Order 2020-10 is not eligible to request or receive PPE distributed by the state or county health departments.

Medical Procedures Effective May 4, 2020
Subject to the conditions outlined below, elective procedures prohibited by Executive Order 20-72 may resume when this order goes into effect. A hospital ambulatory surgical center, office surgery center, dental office, orthodontic office, endodontic office or other health care practitioners' office in the State of Florida may perform procedures prohibited by Executive Order 20-72 only if:

1. The facility has the capacity to immediately convert additional facility-identified surgical and intensive care beds for treatment of COVID-19 patients in a surge capacity situation;
2. The facility has adequate personal protective equipment (PPE) to complete all medical procedures and respond to COVID-19 treatment needs, without the facility seeking any additional federal or state assistance regarding PPE supplies;
3. The facility has not sought any additional federal, state, or local government assistance regarding PPE supplies since resuming elective procedures; and
4. The facility has not refused to provide support to and proactively engage with skilled nursing facilities, assisted living facilities and other long-term care residential providers.

1. A hospital, outpatient surgery provider, or outpatient procedure provider may conduct inpatient surgeries and procedures that, if further delayed, will pose a significant risk to quality of life and any outpatient surgeries or procedures if the hospital or provider complies with the following requirements:
   1. A hospital or provider must have:
      1. Adequate inventories of personal protective equipment (PPE) and access to a reliable supply chain without relying on state or local government PPE stockpiles to support continued operations and respond to an unexpected surge in a timely manner; and
      2. A plan to conserve PPE consistent with guidance from the CDC and Iowa Department of Public Health;
   2. A hospital or provider must have a plan for timely COVID-19 testing of symptomatic patients and staff to rapidly mitigate potential clusters of infection and as otherwise clinically indicated. Providers must comply with any relevant guidance related to testing requirements for patients and staff issued by the Iowa Department of Public Health, the CDC, or a provider's professional specialty society. For scheduled surgeries patients should have a negative CO VID-19 test performed within 48 hours of surgery date. If a COVID-19 test is not available, a hospital or provider should consider alternative methods to determine the patient's probability of CO VID-19. If the patient has symptoms of fever, cough, or low oxygen saturation, then postponing the surgery is recommended.
   3. A hospital must continue to accept and treat COVID-19 patients and must not . transfer COVID-19 patients to create capacity for elective procedures.
   4. A hospital must reserve at least 30% of intensive care unit (ICU) beds and 30% of medical/surgical beds for COVID-19 patients.
   5. A hospital or provider that begins conducting surgeries or procedures as authorized by this paragraph but is no longer able to satisfy all these requirements must cease conducting such surgeries or procedures except as authorized by paragraph B. All hospitals and providers shall have a plan in place to monitor compliance and a transition plan to reduce or suspend procedures and surgeries as necessary.
2. Except as provided in paragraph A, all nonessential or elective surgeries and procedures that utilize PPE must not be conducted by any hospital, outpatient surgery provider, or outpatient procedure provider, whether public, private, or nonprofit.
3. A nonessential surgery or procedure is one that can be delayed without undue risk to the current or future health of a patient, considering all appropriate factors including, but not limited to any:
   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.
4. Each hospital, outpatient surgery provider, and outpatient procedure provider shall limit all nonessential individuals in surgery and procedure suites and patient care areas where PPE is required. Only individuals essential to conducting the surgery or procedure shall be
   present in such areas.
5. Each hospital, outpatient surgery provider, and outpatient procedure provider shall establish an internal governance structure to ensure that the principles outlined above are followed.

Phase 2:

• Begins Wednesday, May 6, 2020
• Outpatient/ambulatory surgery and invasive procedures may resume
• All patients must have COVID-19 pre-procedure testing per professional association guidelines consistent with KDPH guidance
• Each facility must maintain 14-day supply of all necessary PPE based on a projected 14 day burn rate for entire facility
• Type and timing of cases determined by facility-specific procedure prioritization and oversight committee
• For acute care hospitals, maintain at least 30% bed capacity, per facility surge plan, in both ICU and total beds for COVID-19 patients

Phase 3:

• Begins Wednesday, May 13, 2020
• Non-emergent/non-urgent inpatient surgery and procedures may resume at 50% of pre-COVID-19 shutdown volume
• All surgical/procedural patients must have COVID-19 pre-procedure testing per professional association guidelines consistent with KDPH guidance
• Each facility must maintain 14-day supply of all necessary PPE based on a projected 14-day burn rate for entire facility
• Type and timing of cases determined by facility-specific procedure prioritization and oversight committee
• For acute care hospitals, maintain at least 30% bed capacity, per facility surge plan, in both ICU and total beds for COVID-19 patients

Phase 4:

• Begins Wednesday, May 27, 2020
• Non-emergent/non-urgent inpatient surgery and procedures may resume at volume determined by each facility
• All patients must have COVID-19 pre-procedure testing per professional association guidelines consistent with KDPH guidance
• Each facility must maintain 14-day supply of all necessary PPE based on a projected 14-day burn rate for entire facility
• Type and timing of cases determined by facility-specific procedure prioritization and oversight committee
• For acute care hospitals, maintain at least 30% bed capacity, per facility surge plan, in both ICU and total beds for COVID-19 patients

April 27, 2020

1. (i) Medical and surgical procedures are allowed in order to treat an emergency medical condition; for purposes of this Notice, “emergency medical condition” is the definition used in 42 CFR §489.24; such definition states that an “emergency medical condition” is defined as a medical condition manifesting itself by acute symptoms of sufficient severity (including severe pain, psychiatric disturbances and/or symptoms of substance abuse) such that the absence of immediate medical attention could reasonably be expected to result in:
   1. Placing the health of the individual (or, with respect to a pregnant woman, the health of the woman or her unborn child) in serious jeopardy
   2. Serious impairment to bodily functions; or
   3. Serious dysfunction of bodily organs.
2. Medical and surgical procedures are allowed to avoid further harms from underlying condition or disease.
3. Time-Sensitive Medical Conditions:
   1. Subject to paragraph (b) below, medical and surgical procedures are allowed to treat time-sensitive medical conditions, provided that the facility and/or healthcare provider ensure that each of the following conditions/requirements are met; if each of the following conditions/requirements is not met, then the facility/healthcare provider shall not perform any medical or surgical procedures to treat time-sensitive medical conditions:
      1. Each patient undergoing such a medical or surgical procedure shall undergo an appropriate pre-operative clinical evaluation to minimize the risk that the patient has COVID-19; such clinical evaluation shall include appropriate COVID-19 testing, if available;
      2. Each patient undergoing such a medical or surgical procedure shall be required to comply with strict social distancing measures from the time of the pre-operative clinical evaluation through the day of the surgery;
      3. The facility and healthcare provider shall have an adequate and appropriate supply of personal protective equipment (PPE) to treat the patient, as well as treat any other patient, including COVID positive patients, in the facility. At no time shall a facility’s PPE supply to treat COVID positive patient fall below a 5-day supply on hand at the facility. The facility shall not be dependent on the state or other governmental body to supply the 5-day requirement;
      4. There is an adequate supply chain to the facility/healthcare provider for medical equipment, supplies, and medications;
      5. The facility/healthcare provider has adequate medical staff, including surgical, surgical support, recovery, and nursing staff, to meet the needs of all patients;
      6. The facility/healthcare provider shall conduct constant monitoring of hospital, regional, and state resources, as well as ESF-8 reports, indicating coronavirus burden of disease and impact.
   2. Medical and Surgical Procedures to Treat Time-Sensitive Medical Conditions SHALL BE IMMEDIATELY DISCONTINUED upon notice by the State Health Officer, who may consider any of the following criteria in making a decision to halt or discontinue medical and surgical procedures to treat time-sensitive medical conditions:
      1. Statewide or region-wide ventilator capacity;
      2. Statewide or region-wide ICU bed availability;
      3. Statewide or region-wide med surg bed availability;
      4. The number of new admit COVID-19 cases; and
      5. Any other criteria that the State Health Officer deems appropriate.

B. Resumption of Elective and Non-Urgent Medical Procedures - Conditions All licensed healthcare facilities and healthcare providers may resume elective and non-urgent medical procedures and appointments at 7:00 A.M., May 7, 2020 provided all of the following measures are in place:

1. Licensed healthcare providers shall exercise their independent professional judgment in determining what procedures are appropriate to perform, which appointments should occur, and which patients to see in light of widespread COVID19 community transmission.
2. Any licensed healthcare facility or healthcare provider resuming elective and non-urgent medical procedures shall have at least one week’s supply of personal protective equipment (PPE) for themselves, staff, and as appropriate, for patients.

Beginning at 5:00 a.m. on Tuesday, May 26, 2020, the suspension on elective surgeries and invasive procedures instituted in Executive Order No. 109 (2020) is rescinded.

2. Elective surgeries and invasive procedures, as defined by Executive Order No. 109 (2020), may proceed at health care facilities, subject to limitations and precautions set forth in policies, which may include but are not limited to Executive Directives, to be issued by the Department of Health, in consultation with the Division of Consumer Affairs, by Monday, May 18, 2020. The policies to be issued by the Department of Health will address relevant considerations, such as the following:

1. Which types of facilities can resume these procedures;
2. Which specific facilities are eligible to resume these procedures, based upon their current or potential capacity;
3. Whether facilities will be required to prioritize certain procedures, and if so, what considerations should guide these decisions;
4. Personal Protective Equipment requirements for facilities that resume these procedures;
5. Staffing requirements for facilities that resume these procedures;
6. Whether facilities should cohort COVID-19 and non-COVID-19 patients;
7. Requirements for patients seeking these procedures to undergo testing, self-quarantine, or other preventive measures, as applicable;
8. Policies surrounding visitors;
9. Policies surrounding discharge of patients after the procedures are completed; and
10. Reporting metrics regarding the resumption of these procedures.

3. Elective surgeries and invasive procedures, as defined by Executive Order No. 109 (2020), performed by licensed health care providers practicing in outpatient settings not licensed by the Department of Health (e.g., health care professional offices, clinics, and urgent care centers) may proceed, subject to limitations and precautions set forth in policies, which may include but are not limited to rules and administrative orders, to be issued by the Division of Consumer Affairs, in consultation with the Department of Health, by Monday, May 18, 2020.

Medical practitioners may gradually resume operations in compliance with guidelines provided by the New Mexico Department of Health. The guidelines shall be entitled “Reopening Guidelines: Medical Offices.” The guidelines shall be publicly available on the Department of Health website and are subject to change as circumstances warrant. Hospitals and ambulatory surgical facilities may gradually resume operations in compliance with guidelines provided by the New Mexico Department of Health. The guidelines shall be called “Medically Necessary Surgery and Procedural Guidelines.” The guidelines shall be publicly available on the Department of Health website and are subject to change as circumstances warrant. To reopen or expand ambulatory or inpatient surgery, a facility must affirm past compliance with all current Public Health Emergency Orders.

April 28, 2020 if the hospital capacity is over 25 percent for the county and if there have been fewer than 10 new hospitalizations of COVID-19 patients in the county over the past 10 days. If a hospital is located in a county eligible to resume elective outpatient treatments, but that hospital has a capacity under 25 percent or has had more than 10 new hospitalizations in the past 10 days, that hospital is not eligible to resume elective surgeries. If a county or hospital that has resumed elective surgery experiences a decrease in hospital capacity below the 25 percent threshold or an increase of 10 or more new hospitalizations of COVID-19 patients, elective surgeries must cease. Further, patients must test negative for COVID-19 prior to any elective outpatient treatment.

May 13, 2020 Update: Hospital and all ambulatory surgery centers are permitted to resume surgery. Restrictions on elective surgery will remain in place in Bronx, Queens, Rockland, Nassau, Westchester, Richmond, Kings, Suffolk, New York, and Erie Counties as the state continues to monitor the rate of new COVID-19 infections in the region.

1. Non-essential or elective surgeries and procedures that utilized PPE should not be conducted.
2. A non-essential surgery is a procedure that can be delayed without undue risk to the current or future health of a patient. Examples of criteria to consider include:
   1. Threat to the patient's life if 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
   4. Risk of rapidly worsening to severe symptoms (time sensitive)

Beginning at 11:59 pm on April 21 through 11:59 pm on May 8, all licensed health care professionals and all licensed health care facilities must continue to postpone all surgeries and procedures that are not medically necessary to diagnose or correct a serious medical condition of, or to preserve the life of, a patient who without timely performance of the surgery or procedure would be at risk for serious adverse medical consequences or death as determined by a patient's physician. Exceptions now include:

• Any procedure that, if performed in accordance with the commonly accepted standard of clinical practice, would not deplete the hospital capacity or the PPE needed to cope with COVID-19
• Any surgery or procedure performed in a licensed health care facility that has certified in writing to Texas HHSC both (1) that it will reserve at least 25 percent of its hospital capacity for treatment of COVID-19 patients, accounting for the range of clinical severity of COVID-19 patients, and (2) that it will not request any PPE from any public source—whether federal, state, or local—for the duration of the COVID-19 disaster.

Each covered healthcare provider shall:

1. implement the following protocols regarding the use of face masks:
   1. except as provided in Subsection (3)(a)(ii), require each individual in a healthcare facility, including each staff member, patient, and individual accompanying a patient, to wear a mask that covers the nose and mouth
      when within six feet of another individual; and ii. a patient is not required to wear a mask during a procedure involving a facial area of the patient the mask would otherwise cover;
2. permit no more than one individual to accompany each patient;
3. ensure that no individual is permitted to congregate in or near the healthcare facility, including to the extent practicable, requiring a patient to wait outside the healthcare facility or in the individual’s vehicle and escorting the patient directly to a treatment room with minimal social interaction;
4. remove any toy, magazine, and other similar item from each waiting room or area;
5. screen each individual who enters the healthcare facility by:
   1. taking the individual’s temperature; and
   2. administering a questionnaire regarding any symptom consistent with COVID-19 experienced by the individual or a member of the individual’s household or residence;
6. require any individual who shows any symptom consistent with COVID-19, or who reports that a member of the individual’s household or residence shows any symptom consistent with COVID-19, to leave the healthcare facility as soon as reasonably practicable under the circumstances;
7. install a protective barrier that separates patients from front desk personnel or require front desk personnel to wear a mask that covers the nose and mouth;
8. require each healthcare professional to wear a face shield or goggles that seal around the eyes when performing a treatment that creates an aerosol; and
9. maintain using the Electronic Medical Records System, or other appointment log, patient contact information to assist with contact tracing efforts.

4. Each hospital and ambulatory surgical center operating in Utah shall follow the protocols developed by the Utah Hospital Association in consultation with the Utah Department of Health, titled “Utah Roadmap for Resuming Elective Procedures” and dated April 21, 2020.