State-by-State Regulatory Updates Affecting Health Care Organizations During the COVID-19 Pandemic

FEDERAL

1135 waivers: Several states submitted a second 1135 waiver request to CMS. The approved waivers have been published by the Centers for Medicare and Medicaid Services. Unless otherwise stated, all waivers are retroactively effective March 1, 2020.

Arkansas (approved 5/5/2020):

• EFFECTIVE 4/16/2020 - Temporarily suspend Medicaid fee-for-service prior authorization requirements. 
• Temporarily waive written consent required under home and community based service programs and permit documented verbal consent as an alternate.

Iowa (approved 5/5/2020)

• Medicaid/Medicare provider enrollment waivers to expedite and simplify enrollment. 
• Waive conditions of participation or conditions for coverage for existing providers for facilities for providing services in alternative settings, including using an unlicensed facility, if the provider’s licensed facility has been evacuated
• Modification of the allowed timeframe for evaluations and assessments of home and community based services. 
• Modification of the deadline for initial and annual level of care determinations.

Arizona (approved 5/6/2020)

• The state may temporarily authorize reimbursement for home and community based services provided by an entity that also provides case management services and/or is responsible for the development of the person-centered service plan (conflict of interest requirements). 
• Temporarily waive written consent required under home and community based service programs and permit documented verbal consent as an alternate.

Washington (approved 5/6/2020)

• Temporarily allow services to be provided in settings that have not been determined to meet the home and community-based settings criteria.
• The state may temporarily authorize reimbursement for home and community based services provided by an entity that also provides case management services and/or is responsible for the development of the person-centered service plan (conflict of interest requirements). 
• Temporarily waive written consent required under home and community based service programs and permit documented verbal consent as an alternate.

Maryland (approved 5/6/2020)

• Temporarily allow payment for personal care services rendered by legally responsible individuals provided that the state makes a reasonable assessment that the caregiver is capable of rendering such services. 
• Temporarily allow services to be provided in settings that have not been determined to meet the home and community-based settings criteria.
• Temporarily waive written consent required under home and community based service programs and permit documented verbal consent as an alternate.

New York (approved 5/6/2020)

• Temporarily allow services to be provided in settings that have not been determined to meet the home and community-based settings criteria.
• Temporarily waive written consent required under home and community based service programs and permit documented verbal consent as an alternate. 

California (approved 5/8/2020)

• Extend pre-existing authorizations for which a beneficiary has previously received prior authorization through the end of the public health emergency.
• Temporarily allow services to be provided in settings that have not been determined to meet the home and community-based settings criteria.
• Temporarily waive written consent required under home and community based service programs and permit documented verbal consent as an alternate. 

Oregon (approved 5/8/2020)

• Modification of the allowed timeframe for evaluations and assessments of home and community based services. 
• Modification of the deadline for initial and annual level of care determinations.
• Temporarily allow services to be provided in settings that have not been determined to meet the home and community-based settings criteria.
• The state may temporarily authorize reimbursement for home and community based services provided by an entity that also provides case management services and/or is responsible for the development of the person-centered service plan (conflict of interest requirements). 
• Temporarily waive written consent required under home and community based service programs and permit documented verbal consent as an alternate. 

Alabama (approved 5/8/2020)

• Require fee-for-service providers to extend pre-existing authorizations through which a beneficiary has previously received prior authorization through the termination of the emergency declaration.
• Medicaid/Medicare provider enrollment waivers to expedite and simplify enrollment.   

Massachusetts (approved 5/8/2020)

• Temporarily allow services to be provided in settings that have not been determined to meet the home and community-based settings criteria. 

District of Columbia (approved 5/8/2020)

• Temporarily allow services to be provided in settings that have not been determined to meet the home and community-based settings criteria.
• Temporarily waive written consent required under home and community based service programs and permit documented verbal consent as an alternate. 
• Allow managed care enrollees to proceed almost immediately to a state fair hearing without having a managed care plan resolve the appeal first by permitting the state to modify the timeline for managed care plans to resolve appeals to one day so the impacted appeals satisfy the exhaustion requirements
• Give enrollees more than 120 days (if a managed care appeal) or more than 90 days (if an eligibility for fee-for-service appeal) to request a state fair hearing by permitting extensions of the deadline for filing those appeals by a set number of days (e.g., an additional 120 days)
• Modification of the allowed timeframe for evaluations and assessments of home and community based services. 

Nebraska (approved 5/8/2020)

• Require fee-for-service providers to extend pre-existing authorizations through which a beneficiary has previously received prior authorization through the termination of the emergency declaration.

Minnesota (approved 5/8/2020)

• Modification of the deadline for initial and annual level of care determinations.
• Temporarily allow services to be provided in settings that have not been determined to meet the home and community-based settings criteria.
• The state may temporarily authorize reimbursement for home and community based services provided by an entity that also provides case management services and/or is responsible for the development of the person-centered service plan (conflict of interest requirements). 
• Temporarily waive written consent required under home and community based service programs and permit documented verbal consent as an alternate. 

Louisiana (approved 5/11/2020)

• Require fee-for-service providers to extend pre-existing authorizations through which a beneficiary has previously received prior authorization through the termination of the emergency declaration
• Modification of the deadline for initial and annual level of care determinations.
• Temporarily allow payment for personal care services rendered by legally responsible individuals providing services provided that the state makes a reasonable assessment that the caregiver is capable of rendering such services. 
• Temporarily waive written consent required under home and community based service programs and permit documented verbal consent as an alternate. 

Connecticut (approved 5/12/2020)

• Temporarily allow services to be provided in settings that have not been determined to meet the home and community-based settings criteria. 

STATE BOARD REGULATIONS

Board of Pharmacy

California 05/07/2020:

The California State Board of Pharmacy met via teleconference and took the following actions:

• Delegated authority to the president to grant Pharmacy Law waivers for up to 90 days and to extend existing waivers for up to 90 additional days. 
• Approved a proposed regulation Community Pharmacy Staffing.
• Approved a proposed regulation to amend Substantial Relationship and Rehabilitation Criteria.
• Approved a proposed regulation to amend Renewal Requirements.
• Approved a revised policy statement regarding applicability of Board compounding regulations and USP compounding changes.

Extended following waivers:

• To allow compounding of a medium risk investigational drug in a noncompliant compounding environment. Waiver is extended for up to 120 days.
• To allow for alternative use of PPE by staff performing hazardous nonsterile compounding under specific conditions. Waiver is modified and extended at the discretion of the president.

05/12/2020: Allows pharmacists to collect specimens for COVID-19 tests and order tests for consumers. The specimens will be delivered to and processed at public health, university or commercial labs.

Source:  Governor Announcements

Connecticut 05/07/2020: 

Pharmacists are permitted to order and administer Food and Drug Administration approved tests for COVID-19.

Source: Executive Order No. 7KK

Iowa 05/12/2020: 

A pharmacist who has been issued an emergency pharmacist license is authorized to practice pharmacy to the full extent that any other licensed pharmacist is authorized.

Source: Iowa Board of Pharmacy Emergency Pharmacist Licenses

Illinois 05/06/2020: 

Compounding guidance for FDA temporary policy.

Source: Compounding Guidance

Indiana 05/08/2020: 

The expiration of any state agency-issued license, certification or permit to June 4, 2020.

Source: Executive Order 20-27

Kentucky 05/08/2020: 

Pharmacists located in any county in the Commonwealth of Kentucky may dispense emergency refills of up to a thirty (30) day supply of any nonscheduled medication for residents of any county of the Commonwealth. Pharmacists may operate temporarily a pharmacy in an area not designated on the pharmacy permit; Pharmacists may dispense drugs as needed to prevent or treat COVID-19 pursuant to protocols established by the CDC or the NIH or determined to be appropriate by the commissioner of public health or his designee to respond to the circumstances causing the emergency; The provisions of this Order shall expire on June 7, 2020.

Source: Executive Order 2020-322

New Jersey 05/05/2020: 

Recent graduates of pharmacy programs who have not yet been able to take and pass their licensing exams will be granted temporary emergency licenses.

Source: Governor Announcement for Emergency Graduate Licenses

New Mexico 05/05/2020: 

Allows a hospital to obtain compounded sterile preparation from a pharmacy, under outlined circumstances and conditions.

Source:  Emergency Dispensing Declaration

05/11/2020: Pharmacists may administer FDA-authorized tests that can be performed in a patient care setting operating under a CLIA (Clinical Laboratory Improvement Amendments) Certificate of Waiver.

Source: Pharmacist Ordering and Administering COVID-19 Testing

New York 05/05/2020:

Any suspension or modification of any law heretofore suspended in Executive Order 202, or any amended or modified Executive Order issued thereafter, which allowed for the practice of a profession in the state of New York without a current New York State licensure, or registration, including but not limited to those individuals who are validly licensed in another state or Canada, is hereby extended for a period of thirty days to allow those professionals the ability to continue to provide services necessary for the State’s COVID-19 response.

Source:  Executive Order 202.27

North Carolina 05/06/2020: 

When a pharmacy is reviewing an ID as required for dispensing certain controlled substances (see https://www3.verisys.com/e/699093/faqs-PhotoIDFAQ-pdf/29xw69/333947096?h=8uCFubdRiu_cHcRsnH1kS7sFsO-66ZHFyq0ZeVqZ5_E), a North Carolina license whose expiration has been extended by this statute is "current" and acceptable. 

Source:  Emergency Declarations

Ohio 05/05/2020: 

Updated guidance on the authority of pharmacists, pharmacy interns, and certified pharmacy technicians to conduct FDA-authorized COVID-19 testing under certain conditions.

Source: COVID-19 Response Efforts

05/06/2020: The Board’s annual due diligence requirements for drug distributors have been extended until August 31, 2020 (the date was previously extended to June 29, 2020).

Source: COVID-19 Response Efforts

05/08/2020: Director’s Stay Safe Ohio Order implements uniform requirements that pharmacies and other Board of Pharmacy licensees and registrants are required to comply with to remain open.

Source: COVID-19 Response Efforts

Oregon 05/07/2020: 

In-State Pharmacy Drug Compounding: A registered Oregon pharmacy drug outlet, located in Oregon, may compound drugs in shortage in accordance to all requirements set forth in the FDA’s Temporary Policy for Compounding of Certain Drugs for Hospitalized Patients by Pharmacy Compounder Not Registered as Outsourcing Facilities During the COVID-19 Public Health Emergency and other certain requirements.

Source: COVID-19 Updates

Board of Medicine

New Jersey 05/05/2020: 

Recent graduates of physician assistant and respiratory care therapy programs who have not yet been able to take and pass their licensing exams will be granted temporary emergency licenses.

Source: Governor Announcement for Emergency Graduate Licenses 

New Hampshire 05/06/2020: Applicants for a resident training license do not need to provide certification that they have passed USMLE Step 2 (Clinical Skills).

Source: Substantive Waivers Issued Under Med 211.01(f)

Board of Nursing

Illinois 05/05/2020: 

The requirement that certified nursing assistants and developmental disabilities aides complete an approved training program within 120 days of initial employment. These individuals must still demonstrate competency. 

Source:  Emergency Rules

New Jersey 05/05/2020: 

Recent graduates of nursing programs who have not yet been able to take and pass their licensing exams will be granted temporary emergency licenses.

Source: Governor Announcement for Emergency Graduate Licenses

Disclaimer: This information has been gathered from a variety of sources. Although our team at Verisys has made every effort to provide complete, accurate and up-to-date information, Verisys makes no warranties, express or implied, or representations as to the accuracy or reliability of this information. The information is fluid and evolving. Verisys assumes no liability or responsibility for any errors or omissions in the information contained in this resource.

The information contained here comprises all the information that we have found during those dates. It may not constitute a complete list of every regulation instituted by every board during the last week.