State Guidelines for Returning to Practice
As states move to reopen businesses, precautions must still be taken to protect against the spread of COVID-19. States are developing regulations based on their individual circumstances. Many have issued more specific guidance for healthcare providers and performing elective surgeries due to the unique risks they face. The most recent state return-to-practice guidelines are linked below.
On April 28, the Governor issued partial re-openings starting April 30.
"Medical procedures. Effective April 30, 2020, at 5:00 P.M., dental, medical, or surgical procedures may proceed unless the State Health Officer or his designee determines that performing such procedures, or any category of them (whether statewide or regionally), would unacceptably reduce access to personal protective equipment or other resources necessary to diagnose and treat COVID-19. Providers performing these procedures shall follow all applicable COVID-19-related rules adopted by a state regulatory board or by the Alabama Department of Public Health. In the absence of such rules, providers should take reasonable steps to comply with applicable COVID-19-related guidelines from the Centers for Medicare and Medicaid Services (CMS) and the CDC, including “Re-opening Facilities to Provide Non-emergent NonCOVID-19 Healthcare: Phase I” from CMS, available at https://www.cms.gov/files/document/covid-flexibility-reopen-essential-non-covid-services.pdf, and “Infection Control Guidance for Healthcare Professionals about Coronavirus (COVID-19)” from the CDC, available at https://www.cdc.gov/coronavirus/2019-ncov/hcp/infectioncontrol.html..."
The Governor issued a Health Mandate on April 15, Section I businesses reopening starting April 15, Section II began May 4.
"a. Health care facilities and providers defined in statute, and listed in Section IV, will be able to resume low-risk, routine-type services which require minimal protective equipment by complying with the requirements listed in i. through viii. below. This section is intended to apply to services that do not require special or invasive procedures – examples include, but are not limited to, annual physical examinations, prenatal appointments, and routine dental cleanings..."
The Governor issued a Health Mandate April 21 announcing a phased reopening starting April 24, until amended, rescinded, or suspended.
"The State of Alaska is issuing its sixteenth health mandate, based on its authority under the Public Health Disaster Emergency Declaration signed by Governor Mike Dunleavy on March 11, 2020. This Mandate will go into effect April 24, 2020. The State of Alaska reserves the right to amend the Mandate at any time."
- Visit the Alaska Department of Health and Social Services website.
- Read the DOH Resources for Health Care workers.
An Executive Order 4/22/2020, allowing certain exemptions to resume elective surgeries on or after 5/1/2020
"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..."
An Exemption from Executive Order to request elective surgeries
Requesting Exemption from Executive Order 2020-10: Elective Surgeries..."
A Directive effective 4/27/2020 resuming elective procedures under certain conditions
"This directive emphasizes the need for facilities to understand their capabilities (e.g., beds, testing, ORs) as well as potential constraints (e.g. workforce, supply chain), while watching for possible subsequent waves of the virus, which may require a return to prior restrictions. Elective procedures shall be limited as follows: 1. Only outpatients with no plans for overnight stay. 2. An American Society of Anesthesiologists rating of I or II. If they are a II-rating, their disease process should be well controlled. 3. No contact with known COVID-19 patients during the past 14 days. 4. Patients must be asymptomatic for COVID-19 per ADH guidelines. 5. Start with a small initial volume of cases and increase incrementally as PPE availability and number of statewide occurrences dictate. 6. Each institution must have an ample supply of PPE for resuming elective procedures while maintaining a reserve should there be a resurgence of the virus. The acquisition of PPE is a matter for each institution to address and is not the responsibility of ADH. 7. 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..."
An Order effective 3/19/2020 until further notice halting elective procedures
"The healthcare delivery system shall prioritize services to serving those who are the sickest and shall prioritize resources, including personal protective equipment, for the providers providing direct care to them."
An Amended Order 5/5/2020 effective 4/27/2020 until 5/26/2020 resuming elective surgeries
"Executive Order D 2020 045 authorizes voluntary or elective surgeries and procedures to begin again under certain conditions..."
A Recommendation posted 3/17/2020 halting elective procedures
“...In addition to halting all hospital elective procedures, the District of Columbia Department of Health (DC Health) is recommending that ALL elective medical procedures, non-urgent hospital and outpatient visits, and non-urgent dental procedures be postponed to preserve health care capacity as our community mitigation strategies work to flatten the epidemic curve.”
Guidelines for resuming elective procedures 4/29/2020 Phase 1 effective 5/4/2020
"Upon the expiration of Executive Order 20-72 on May 8, 2020, healthcare practitioners should resume all inpatient and outpatient elective procedures at hospitals, ambulatory surgical centers, office surgery centers, dental, orthodontic and endodontic offices, and other health care practitioners’ offices. The Governor should authorize the Agency for Health Care Administration and the Florida Department of Health..."
- Visit the Florida Health website for updates.
An Executive Order 4/20/2020 to begin procedures 4/24/2020
"...all medical practices, dental practices, orthodontics practices, optometry practices...should begin treating patients as soon as practicable..."
An Executive Order 4/16/2020 cancelling elective surgeries during the emergency
"Pursuant to sections 127A-12(a)(5) and 663-1.5, HRS, I direct all health care facilities, health care professionals, and health care volunteers, as defined in section 1 of this Executive Order, to render assistance in support of the State’s response to the disaster recognized by the Emergency Proclamations. For health care facilities, “rendering assistance” in support of the State’s response includes cancelling or postponing elective surgeries and procedures as each facility determines to be appropriate under the circumstances presented by the COVID-19 emergency if elective surgeries or procedures are performed at the health care facility. In addition, for health care facilities, “rendering assistance” in support of the State’s response must include measures such as increasing the number of beds, preserving personal protective equipment..."
A Guidance 4/24/2020 beginning 5/11/2020 resuming elective procedures
"Beginning on May 11, 2020, hospitals and ASTCs may begin to perform procedures, provided that specific criteria have been met. A. Outpatient Procedures. For purposes of this policy guidance, an elective outpatient procedure is defined as an elective procedure in which the likely and expected course for the patient undergoing the procedure is that the patient will enter and leave the facility on the same day that the procedure is to be performed. Such procedures may be performed at ASTCs or at hospitals..."
An Executive Order 4/24/2020 resuming elective procedures effective 4/26/2020
"Elective procedures may resume as of 11:59 p.m. on Sunday, April 26, 2020. Health care providers and facilities may resume these procedures so long as they have adopted policies and best practices..."
A Public Health Proclamation resuming elective surgeries effective 4/27/2020
"A hospital, outpatient surgery provider, or outpatient procedure provider may conduct in-patient 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..."
An Executive Order regarding temporary relief from certain restrictions for medical services effective immediately until 5/31/2020
"Any and all provisions in Kansas Statutes relating to supervision, delegation, and related issues by and to healthcare providers that are licensed, registered or certified and ancillary workers, are temporarily suspended, in whole or part, to the extent necessary to allow licensed, registered, or certified health care professionals to provide, with a designated health care facility at which the professional is employed or contracted to work, medical services that are necessary to support the facility's response to the COVID-19 pandemic and are appropriate to the professional's education, training, and experience, as determined by the facility..."
An Order 5/1/2020 resuming elective procedures starting 5/6/2020
"As of May 6, 2020 outpatient/ambulatory surgery and invasive procedures may resume.."
A Proclamation 4/30/2020 halting elective procedures
"Louisiana state licensure laws, rules, and regulations for medical professionals and personnel hereby remain suspended for those medical professionals..."
An Amended Directive and Order resuming elective procedures effective 5/7/2020
"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: I. 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..."
A Guidance 3/15/2020 effective until rescinded or State of Emergency is terminated cancelling elective procedures
"Pursuant to an Order issued by the Commissioner of Public Health, and to focus health care personnel resources on responding to this outbreak and conserve the critical shortage of personal protective equipment, all hospitals and ambulatory surgical centers are directed to postpone or cancel any nonessential, elective invasive procedures until the State of Emergency is terminated by the Governor, or until rescinded by the Commissioner of Public Health, whichever shall happen first.
An Executive Order 5/21/2020 resuming certain elective procedures starting 5/29/2020 by appointment
"In addition, because our healthcare capacity has improved with respect to personal protective equipment, available beds, personnel, ventilators, and necessary supplies, I find it reasonable to rescind Executive Orders 2020-17 and 2020-34, which required health-care and veterinary facilities to implement plans to postpone some medical and dental procedures. Those rescissions will take effect on May 29..."
An Executive Order 5/5/2020 resuming elective surgeries starting 5/11/2020
"...to resume the provision of many currently delayed procedures once facilities have adequately planned to prioritize the ongoing COVID-19 response; develop criteria for determining which procedures should proceed..."
An Executive Order 4/24/2020 resuming elective procedures
"Healthcare professionals and healthcare facilities may also resume performing non-emergent, elective medical procedures and surgeries, as clinically appropriate..."
- Visit the Mississippi State Department of Health website.
- Read the Governor's Executive Order 1478 reopening certain businesses
- Read the Governor's Executive Order 1477 extending the stay-at-home order
- Reopening the Big Sky Presentation
- Read the Governor's Directive Implementing Executive Orders 2-2020 and 3-2020 reopening certain businesses
A Directed Health Order 4/3/2020 effective during the emergency halting certain procedures
“...a surgery or procedure that is scheduled in advance because it does not involve a medical or dental emergency ... surgeries or procedures that must be done to preserve the patient’s life or physical health, but do not need to be performed immediately, are allowed by a case-by-case determination of the medical or dental provider.”
- Nevada Health Response to COVID-19
- Read the Governor's Nevada United Roadmap to Recovery Plan update regarding reopening certain businesses
A Guidance for hospitals for resuming health care services starting 5/4/2020
"Timing for Resuming Services There should be a capacity to provide safe care for the current patient population, including both COVID-19 positive and non-COVID-19 patients, who require hospitalizations. The facility shall continuously monitor and have appropriate number of intensive care unit (ICU) and non-ICU beds, PPE, ventilators, medications and trained staff to treat all patients. Crisis standards of care should not be active. Based on local assessments of the conditions in the communities they serve regarding levels of hospitalization and overall capacity, health system leaders would make the determination of when to begin the phasing in of time sensitive health care services, which could be as soon as May 4, 2020..."
An Order effective 3/27/2020 halting elective surgeries
"Beginning at 5:00 p.m. on Friday, March 27, 2020, all “elective” surgeries performed on adults, whether medical or dental, and all “elective” invasive procedures performed on adults, whether medical or dental, are suspended in the State. An “elective” surgery or invasive procedure, for purposes of this Order, is defined as any surgery or invasive procedure that can be delayed without undue risk to the current or future health of the patient as determined by the patient’s treating physician or dentist..."
An Order 3/24/2020 effective 3/27/2020 for the duration of Executive Order 2020-004 or until rescinded halting non-essential health care services
“...all hospitals and other health care facilities, ambulatory surgical facilities, dental, orthodontic and endodontic offices in the State of New Mexico…from providing non-essential health care services, procedures, and surgeries.”
Guidelines 5/8/2020 for resuming medically necessary surgical procedures
"A revision to the 4/28/20 document released by the MAT, the following is a framework for restarting medically necessary surgical procedures in hospital and ambulatory surgical centers (ASC) settings: A separate set of recommendations is available for office-based procedures and medical care. These services will be essential as ancillary services to surgical patients to enable pre-and post-operative care..."
Guidelines for reopening medical offices 5/8/2020
"A revision to the 4/28/20 document released by the MAT, the following guidelines are recommended for use by allopathic and osteopathic medical providers working in an office setting (non-procedural and procedural), physical and occupational therapy facilities, and imaging facilities. These guidelines are not intended for dentists, chiropractors, alternative medicine, or veterinary medicine. Dental office environments are classified in a “very high-risk exposure” category by the CDC and will require enhanced measures to protect dental health care personnel. Recommendations for dental offices can be found here..."
An Announcement 5/13/2020 resuming elective surgeries in 12 more counties
"...Amid the ongoing COVID-19 pandemic, Governor Andrew M. Cuomo today announced 12 more counties are now eligible to resume elective surgeries. The Governor previously announced that the state will allow elective outpatient treatments to resume in counties and hospitals without significant risk of COVID-19 surge in the near term, and a total of 47 counties can now resume elective surgeries..."
A Letter effective 3/23/2020 for 4 weeks suspending elective procedures
"Effective March 23rd, 2020, as part of a unified response, I request all hospitals and ambulatory surgery centers suspend all elective and non-urgent procedures and surgeries. Elective and non-urgent procedures and surgeries are defined as any procedure or surgery that if not done within the next 4 weeks would cause harm to the patient..."
- Guidance for Healthcare Professionals
- Read the Governor's Staying Ahead of the Curve Plan for reopening the state
- Read the Governor's 3 Phase Plan for reopening certain businesses
An Order effective 4/30/2020 until 5/29/2020 resuming elective surgeries
"Effective at 11:59 p.m. on April 30, 2020, medical providers, including dentists in the State may resume non-essential surgeries and procedures..."
A Guide for health care reopening in phases, Step 2 beginning 5/1/2020
"Healthcare providers and facilities that plan to resume providing these services must adhere to infection control practices, have sufficient PPE, and talk with patients about the risk of contracting COVID-19. Surgeries and procedures that, if not performed, would cause a threat to a patient's life, a threat of the spread of cancer or the permanent dysfunction of a limb or organ, the presence of severe symptoms causing an inability to perform activities of daily living, and/or the risk of rapidly worsening symptoms have always been permitted even if an overnight stay is necessary..."
- Read the Ohio Department of Health's Responsible RestartOhio Guide
- Read the Director of Health's Stay Safe Ohio Order reopening certain businesses
An Amended Executive Order 4/16/2020 effective after 4/24/2020
"Elective procedures after April 24th, 2020 are subject to the guidelines set forth in Executive Memo 2020-02..."
An Executive Memorandum 4/16/2020 resuming elective surgeries
"On April 16th, I issued the Second Amended Executive Order 2020-13 allowing elective surgeries to be reinstated on April 24, 2020. It is important to establish priorities for types of procedures to the limit the spread of COVID-19 ... Elective Surgery Acuity Scale..."
An Order effective 3/23/2020 for 90 days cancelling elective procedures
"No later than March 23, 2020, all elective and non-urgent procedures across all care settings that utilize PPE, including but not limited to, hospitals, ambulatory surgery centers, outpatient clinics (including community health clinics and student health centers), dental clinics, and veterinary clinics, shall be cancelled..."
- Oregon Health Authority Healthcare Partner Resources
- OHA Strategies to Limit Spread and Increase Capacity in Health Care Settings
- Read the Governor's Reopening Oregon Plan
A Plan to Reopen the state
Oregon Public Health Division
Guidance on Hospital Responses 5/23/2020 effective with the emergency
"Hospitals may begin to allow elective admissions and may begin performing elective surgeries and procedures if the hospital makes an affirmative decision that it is able to do so without jeopardizing the safety of patients and staff or the hospital’s ability to respond to the COVID19 emergency..."
Guidance posted 5/9/2020 for healthcare providers
"... guidance should be followed by all health care providers, as defined by the Governor’s Order issued on March 19, 2020, and subsequently amended, except hospitals, ambulatory surgical facilities, dental practices, and any others operating under separate Department guidance ..... Providers may resume non-urgent and elective care in addition to providing urgent and emergency care, only when appropriate personal protective equipment (PPE) is available and telemedicine is not clinically sufficient..."
An Executive Order 4/6/2020 effective until 5/31/2020 postponing elective surgeries
“...postpone all non-essential surgeries to conserve (and thereby maximize) supplies of personal protective equipment (PPE).”
An Executive Order 4/8/2020 effective 4/9/2020 until 4/30/2020 postponing elective surgeries
“...all healthcare professionals and healthcare facilities in the State of Tennessee shall postpone surgical and invasive procedures that are elective and non-urgent. Elective and non-urgent procedures are those that can be delayed until the expiration of this Order because they are not required to provide life-sustaining treatment, to prevent death or risk of substantial impairment of a major bodily function, or to prevent rapid deterioration or serious adverse consequences to a patient’s physical condition if the surgical or invasive procedure is not performed, as reasonably determined by a licensed medical provider.”
An Executive Order 5/5/2020 effective until 5/19/2020 reopening some elective surgeries
"...do hereby order the following on a statewide basis effective immediately, and continuing through May 19, 2020, subject to extension based on the status of COVID-19 in Texas and the recommendations of the Governor’s Strike Force to Open Texas, the White House Coronavirus Task Force..."
- DSHS Resuming Elective Procedures Guidance and more
- Read the Governor's Executive Order GA-18 reopening certain services
An Order effective 5/1/2020 until 5/15/2020 permitting elective procedures unless rescinded or extended
"1. The state public health order issued on March 23, 2020, relating to elective surgeries and procedures, is hereby rescinded .... 3. Each covered healthcare provider shall: a. implement the following protocols ...."
An Addendum 5/6/2020 effective until 5/15/2020 resuming certain elective procedures
"hereby authorize the Commissioner of the Vermont Department of Public Health to issue mitigation requirements and procedures for the resumption of clinic visits, diagnostic imaging and such outpatient surgeries and procedures that have a minimal impact on inpatient hospital bed capacity and PPE levels, including those performed in the office or ambulatory surgical care setting. The Commissioner of the Department of Public Health, with the approval of the Governor, may, from time-to-time, update and modify the mitigation requirements and procedures regarding the resumption of additional adult elective surgery and medical and surgical procedures, including dental procedures..."
Guidelines 5/15/2020 for resuming outpatient procedures
"Outpatient clinic visits and diagnostic imaging can resume immediately if providers adhere to the following Mitigation Requirements: Patients must be confident that the environment where they will receive care is safe.
This guidance applies to licensed health care providers under Title 26 of the Vermont Statutes Annotated, though excludes dentistry and dental hygiene, whose practice will be subject to sector-specific guidance..."
- Vermont DOH website
- Read the Governor's Addendum 10 to Executive Order 01-20 reopening low risk workplaces
An Order effective 4/17/2020 until 6/10/2020 prohibiting certain procedures
"...prohibiting all inpatient and outpatient surgical hospitals…free-standing endoscopy centers, physicians’ offices, and dental, orthodontic, and endodontic offices in the Commonwealth from providing procedures and surgeries that require PPE, which if delayed, are not anticipated to cause harm to the patient by negatively affecting the patient’s health outcomes, or leading to disability or death.”
- Visit the Washington State Department of Health website
- DOH Healthcare Facilities FAQs
- Read the Phased Approach for reopening the state
- Read the Governor's Plan 'Safe Start Washington'
An Executive Order 4/20/2020 resuming certain medical procedures
"More urgent elective medical procedures may be resumed at a hospital or ambulatory surgical center that is regulated by OHFLAC..."
A Guidance 4/24/2020 recommending suspending elective procedures
"While the Wyoming Department of Health and Governor’s Office did not prohibit elective procedures through statewide orders, hospitals and providers were encouraged to follow guidance from CMS and CDC that recommended suspending these procedures in order to preserve PPE and protect Wyoming’s hospital capacity during the outbreak. The Department is grateful to hospitals and providers who have suspended these procedures while the state manages the COVID-19 outbreak. On April 19, 2020, the Centers for Medicare and Medicaid Services (CMS) released updated recommendations to healthcare providers regarding the “re-opening of facilities” that provide non-emergent and non-COVID-19 care and procedures (referred to in this document as ‘elective procedures’)..."
*States marked with an asterisk have issued guidance on returning to practice and have been updated since 5/27/2020.
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Coronavirus (COVID-19) Information Center
NEW COVID-19: Returning to Practice Guide
Visit the Returning to Practice Guide page for frequently updated resources to help you safely return to an office-based practice while guarding against COVID-19 risks.
Dept. of Insurance (DOI) Bulletins
More than 30 state DOIs have issued guidance regarding premium payment, cancellations or nonrenewal notice grace periods.
State Immunity and Standard of Care Updates
Certain states are granting healthcare providers immunity or making declarations on the standard of care.