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Recap of Executive & State Agency Orders Related to Public Health

The continued spread of COVID-19 has had a significant impact on the operations of healthcare businesses charged with ensuring the health and wellbeing of Connecticut residents.  As a result, Governor Lamont and the Commissioner of the Department of Public Health (“DPH”) have issued numerous Orders and guidance impacting various aspects of healthcare delivery and other public-health-related matters.  These Orders and guidance are summarized and linked below.

  • On March 10, 2020, Governor Lamont declared a public health and civil preparedness emergency throughout the State of Connecticut through September 9, 2020 (“Declaration”). As part of the Declaration, he empowered the Commissioner of DPH to delegate powers regarding isolation and quarantine to municipal and district directors of public health.  He further directed municipalities and local health and education officials to follow previously issued guidance and principles of risk management in making decisions about public gatherings, events and travel.  The Governor also indicated that he would issue Orders to protect public safety, including the suspension or modification of statutes as necessary.   https://portal.ct.gov/-/media/Office-of-the-Governor/News/20200310-declaration-of-civil-preparedness-and-public-health-emergency.pdf?la=en 
  • On March 14, 2020, Governor Lamont issued Executive Order No. 7B, which among other things suspended in-person open meeting requirements, including the requirement that in-person hearings and meetings be held by DPH and its divisions. These meetings may now proceed remotely by conference call, videoconference or other technology provided that (i) the public has the ability to view or listen to the meeting in real time; (ii) the meeting is recorded or transcribed and made available on the agency’s website; (iii) notice of the meeting includes information on how the public can access the meeting; (iv) relevant materials are posted on the agency’s website for public inspection prior to the meeting; and (v) all speakers state their name and title before speaking.  https://portal.ct.gov/-/media/Office-of-the-Governor/Executive-Orders/Lamont-Executive-Orders/Executive-Order-No-7B.pdf?la=en 
  • On March 19, 2020, Governor Lamont issued Executive Order 7G, which among other things modifies the DPH statutes regarding telehealth services. Medicaid enrolled providers and in-network providers for commercial fully insured health plans may now perform telehealth services through the use of audio-only telephone.  DPH has suspended licensure, certification and registration of these same providers as telehealth providers and they are permitted to use additional information and communication technologies consistent and in accordance with any HIPAA guidance issued by the U.S. Department of Health and Human Services Office for Civil Rights.  Providers can also offer telehealth services to individuals other than Medicaid beneficiaries and those who are fully commercially insured provided that they determine whether the patient has a plan with telehealth coverage and do not bill a patient for any additional charges beyond what the plan covers.  For uninsured patients, a telehealth provider must accept the amount that Medicare reimburses for such services, offering financial assistance as needed.  Moreover, any requirement that a telehealth provider conduct telehealth visits from a licensed facility is waived.  https://portal.ct.gov/-/media/Coronavirus/20200318-DPH-Change-to-the-List-of-Reportable-Laboratory-Findings.pdf?la=en  
  • On March 23, 2020, Governor Lamont issued Executive Order 7K, which among other things authorized the DPH Commissioner to temporarily waive, modify or suspend any regulatory requirements adopted by DPH or any Boards or Commissions under its purview as deemed necessary to reduce the spread of COVID-19 and protect the public health. Executive Order 7K also suspended the statutory requirement that long-term care facilities submit background searches before employing or contracting with or allowing anyone to volunteer who has direct patient access.  Instead, the requirements for conditional work pending background screening set forth in 19a-491c(f)(A) through (D) of the Connecticut General Statutes apply.  https://portal.ct.gov/-/media/Office-of-the-Governor/Executive-Orders/Lamont-Executive-Orders/Executive-Order-No-7K.pdf?la=en 
  • Also on March 23, 2020, DPH issued an Order temporarily suspending for a period of sixty (60) days the requirements for licensure, certification or registration under the chapters governing EMS services and personnel, medicine and surgery, physical therapists, nursing, nurse’s aides, respiratory care practitioners, psychologists, marital and family therapists, clinical social works and masters social workers, professional counselors, and pharmacists in order to allow persons appropriately licensed, certified or registered in another state to render temporary assistance in Connecticut within the scope of their license, certificate or registration. In-state entities that contract with out-of-state providers must verify their credentials and confirm adequate malpractice and other insurance coverage.  The Order also discusses how these providers can be reimbursed for patient-care services.  https://portal.ct.gov/-/media/Coronavirus/20200323-DPH-order-allowing-outofstate-practitioners-to-render-temporary-assistance-in-Connecticut.pdf?la=en 
  • On March 27, 2020, Governor Lamont issued Executive Order 7O, which among other things suspended requirements for license renewal and inspections by DPH. Executive Order 7O also modified healthcare provider identification badge requirements, which allows providers to use a badge from their healthcare facility or institution while providing care, with permission, at another healthcare facility or institution.  Executive Order 7O also instructs the Commissioner of DPH to establish any necessary policies and procedures regarding badging of COVID-19 response personnel should it be necessary to rapidly move staff due to the need for mass care in a circumstance of limited resources.  https://portal.ct.gov/-/media/Office-of-the-Governor/Executive-Orders/Lamont-Executive-Orders/Executive-Order-No-7O.pdf?la=en 
  • Also on March 30 2020, DPH issued an Order authorizing subregistrars to issue burial transit, removal and cremation permits. The Order also authorizes DPH itself to register death certificates and carry out other duties related to the registration of deaths, including the issuance of burial transit, removal and cremation permits if the registrar of a given town is unable to perform these duties.  https://portal.ct.gov/-/media/Coronavirus/20200330-DPH-order-on-reporting-deaths.pdf?la=en 
  • On April 1, 2020, Governor Lamont announced a medical surge plan in collaboration with Connecticut’s nursing homes. The plan involves relocating certain nursing home residents and the creation of dedicated spaces for residents who are COVID-19 positive.  Specifics of the plan include: 
  • Anyone diagnosed as COVID-19 positive in a hospital and later admitted to a nursing home will be monitored and assessed for 14 days in an area that has other COVID-19 positive residents. Admitted residents who are negative for the diseases will be housed with COVID-19 negative residents only.
  • Each nursing home will dedicate specific units to group together COVID-19 positive residents.
  • Certain residents of nursing homes who test negative for COVID-19 or show no symptoms may voluntarily transfer to nursing homes where there are no COVID-19 positive residents. At the same time, some facilities will be converted to house and take admission of COVID-19 positive residents only.
  • Alternate care sites, including some recently-closed nursing home sites, are being developed to further assist with treatment of COVID-19 nursing home residents. 
  • On April 7, 2020, the medical surge plan described above was updated to include: 
  • The designation of dedicated COVID-19 recovery facilities for nursing home residents to be located in existing/vacant facilities in Torrington, Bridgeport, Meriden, and Sharon.
  • Increased COVID-19 testing of hospitalized nursing home residents with the expectation that many will receive the requisite two (2) negative tests within 24 hours and can be discharged to general long-term care facilities. 
  • On April 7, 2020, Governor Lamont issued Executive Order 7V, which among other things addressed the following in regards to individual practitioner licensure: 
  • Waived any application fees for temporary permits to extend the duration of the temporary permits for athletic trainers, respiratory care practitioners, physicians assistants, occupational therapists/assistant, masters social workers for the duration of the civil preparedness and public health emergency.
  • Authorized practice prior to licensure by applicants and graduates for physical therapists, physical therapy assistants, radiographers, registered nurses, nurse practitioners clinical nurse specialists and nurse anesthetists for the duration of the civil preparedness and public health emergency. 
  • Modified statute to provide that, for the duration of the civil preparedness and public health emergency, a license is not required to practice as a marital and family therapy associate provided the person so practicing has completed a graduate degree program specializing in marital and family therapy offered by a regionally accredited institution of higher education or a post graduate clinical training program accredited by CAMFTE offered by a regionally accredited institution of higher education.
  • Permits a person who has completed the requirements in Section 20-195dd( b) of the Connecticut General Statutes to practice as a professional counselor associate without obtaining a license for the duration of the civil preparedness and public health emergency. 
  • On April 11, 2020, Governor Lamont issued Executive Order 7Y, which among other things addressed the following: 
  • Suspension of requirement that nursing homes reserve a bed for a hospitalized resident upon notification that such resident will be placed post-hospitalization into a COVID Recovery Facility or alternative facility due to COVID-19 infection.
  • Designation of certain facilities as COVID Recovery Facilities;
  • Defining a “COVID-19 Transfer” for patient transfers and including such transfer within the definition of emergency.
  • Directing the discharge procedures for recovered residents of COVID Recovery Facilities and stating that notice of discharge and discharge plan are not required.
  • Providing that there is no hearing or court order requirement for (i) transfer of a hospital patient to a COVID Recovery Facility, (ii) a COVID-19 transfer or (iii) a COVID-19 Recovered Discharge.
  • Clarification that the transfer deadline extensions, pursuant to Executive Order 7L, apply to COVID-19 transfer patients. 

https://portal.ct.gov/-/media/Office-of-the-Governor/Executive-Orders/Lamont-Executive-Orders/Executive-Order-No-7Y.pdf

  • On April 11, 2020, after the Centers for Medicare & Medicaid Services (“CMS”) waived certain regulations to allow non-SNF buildings to be temporarily certified and available for use by a SNF to isolate COVID-19 positive residents, DPH authorized licensed nursing homes to provide services for COVID-19 positive patients under their existing licenses in buildings not physically connected to their facilities. In order to provide services in a separate building the nursing home must enter into a Consent Order with DPH certifying that the proposed building, equipment and staff sufficiently address the safety and needs of resident staff and specifying the number of beds to be added.  https://portal.ct.gov/-/media/Coronavirus/20200411-DPH-Order-Modifying-Regs-re-Alternate-COVID-Recovery-Facilities.pdf?la=en   
  • On April 22, 2020, Governor Lamont issued Executive Order 7DD, which among other things addressed the following: 
  • Provides increased flexibility for Medicaid-enrolled providers and in-network providers for commercial fully insured health insurance to perform telehealth through additional methods including the use of audio-only telephone; suspends requirements for the licensure, certification or registration of such telehealth providers; allows such telehealth providers to provide services utilizing communication technologies consistent with the Department of Health and Human Services Office of Civil Rights HIPAA enforcement guidance; and requires such telehealth providers to ascertain insured status and places certain limitations on reimbursement.
  • Allows DPH to add to the list of permissible (unlicensed) out-of-state healthcare providers occupational therapists, alcohol and drug counselors, certain radiology technicians, dentists, dental hygienists, behavior analysis, genetic counselors, music and art therapists, dieticians-nutritionists, and speech and language pathologists.
  • Authorizes participation in intern, resident physician, or United States medical officer candidate training programs prior to permit issuance.
  • Authorizes participation in resident physician assistant program prior to permit issuance.
  • Temporarily suspends physician assistant supervision restrictions.
  • Temporarily suspends in-person supervision requirement for advanced practice registered nurses.
  • Authorizes provision of services by respiratory care therapist and respiratory care technician students.
  • Suspends continuing education requirement for health care providers. 

https://portal.ct.gov/-/media/Office-of-the-Governor/Executive-Orders/Lamont-Executive-Orders/Executive-Order-No-7DD.pdf 

  • On May 6, 2020, DPH issued an Order eliminating the requirement that a request for COVID-19 testing be made by a licensed physician or other provider authorized by law to make a diagnosis. Eliminating the need for a healthcare practitioner order will assist in meeting the mass need for testing of Connecticut residents.  It allows, for example, pharmacists to test for COVID-19 without a physician’s order.  
  • On May 9, 2020, DPH issued an Order revising its prior orders banning visitors at LTC Facilities. The order requires that LTC Facilities:
    • Regularly facilitate reasonable and practical alternative means of communication between residents and their families and other individuals denied entry due to the visitor restriction policy on at least a weekly basis. This includes window visits, virtual visitations via technological solutions, social media communications, and phone calls. 
    • Work together with families and patient representatives to schedule visits and alternate communication. Visits and alternate communications should be for a minimum of twenty (20) minutes and should not be structured in such a way as to overwhelm LTC Facility staff.
    • Regularly inform residents and family members of the availability of alternate communication options and provide guidance and assistance to residents in the use of technology to facilitate such communications.
    • Advise the LTC Ombusdman to the extent that a Facility cannot implement the Order and work together on communication/visitation alternatives. 

In addition to the foregoing, DPH maintains a Blast Fax Page that includes guidance and other documents transmitted to licensed providers during the COVID-19 pandemic.  These documents can be accessed at https://portal.ct.gov/DPH/Facility-Licensing--Investigations/Facility-Licensing--Investigations-Section-FLIS/Blast-Fax-Page 

If you have any questions or need assistance with DPH or other healthcare-related issues, contact Jennifer Groves Fusco at (203) 786-8316 or jfusco@uks.com. 

Disclaimer: The information contained in this material is not intended to be considered legal advice and should not be acted upon as such. Because of the generality of this material, the information provided may not be applicable in all situations and should not be acted upon without legal advice based on the specific factual circumstances.