ORDER OF THE GOVERNOR OF THE COMMONWEALTH OF …

COMMONWEALTH OF PENNSYLVANIA OFFICE OF THE GOVERNOR

ORDER OF THE GOVERNOR OF THE COMMONWEALTH OF PENNSYLVANIA TO ENHANCE PROTECTIONS FOR HEALTH CARE PROFESSIONALS

WHEREAS, the World Health Organization and the Centers for Disease Control and Prevention have declared the coronavirus disease 2019 ("COVID-19") a pandemic; and

WHEREAS, the President of the United States of America has declared the COVID-19 outbreak a national emergency and the U.S. Department of Health and Human Services ("HHS") Secretary has declared the COVID-19 outbreak a public health emergency; and

WHEREAS, pursuant to section 7301(a) of the Emergency Management Services Code, 35 Pa. C.S. ? 7301(a), I am charged with the responsibility to address dangers facing the Commonwealth of Pennsylvania ("Commonwealth") that result from disasters; and

WHEREAS, on March 6, 2020, pursuant to section 7301(c) of the Emergency Management Services Code, 35 Pa. C.S. ? 7301(c), I proclaimed the existence of a disaster emergency throughout the Commonwealth as a result of COVID-19; and

WHEREAS, I am authorized pursuant to section 7301(b) of the Emergency Management Services Code, 35 Pa. C.S. ? 7301(b), during a disaster emergency to issue, amend and rescind executive orders, proclamations and regulations, and those directives shall have the force and effect of law; and

WHEREAS, I am specifically authorized pursuant to section 7301(f) of the Emergency Management Services Code, 35 Pa. C.S. ? 7301(f), to suspend the provisions of any regulatory statute prescribing the procedures for conduct of Commonwealth business, or the orders, rules or regulations of any Commonwealth agency, if strict compliance with the provisions of any statute, order, rule or regulation would in any way prevent, hinder or delay necessary action in coping with the emergency; and

WHEREAS, pursuant to the Proclamation of Disaster Emergency that I issued on March 6, 2020, I suspended the provisions of any regulatory statute prescribing the procedures for conduct of Commonwealth business, or the orders, rules or regulations of any Commonwealth agency, if strict compliance with the provisions of any statute, order, rule or regulation would in any way prevent, hinder or delay necessary action in coping with this emergency and authorized Commonwealth agencies to implement emergency assignments without regard to procedures required by other laws, except mandatory constitutional requirements, pertaining to the performance of public works, entering into contracts, incurring of obligations, employment of temporary workers, rental of equipment, purchase of supplies and materials, and expenditures of public funds; and

WHEREAS, pursuant to the authority to suspend such regulatory statutes, rules or

regulations,

my Administration has suspended numerous regulatory

statutes,

rules and regulations that would have otherwise hindered or delayed the Commonwealth's medical

professional community in responding to the threat of COVID-19; and

WHEREAS, at my direction, on March 18, 2020, pursuant to 35 Pa. C.S. ? 7301, my Administration issued guidance to health-related Pennsylvania licensees that they are permitted to use telemedicine when appropriate. In addition, my Administration granted a temporary suspension of the requirement for out-of-state practitioners to be licensed in Pennsylvania to practice telemedicine so long as they are licensed in good standing in their home state, territory or country by the equivalent of the Pennsylvania State Boards of Chiropractic, Dentistry, Medicine, Nursing and Nursing Home Administrators, Occupational Therapy, Optometry, Osteopathic Medicine, Pharmacy, Physical Therapy, Podiatry, Psychology, Social Work, Speech-Language Pathology and Audiology, and Veterinary Medicine; and

WHEREAS, at my direction, on March 18, 2020, pursuant to 35 Pa.

C.S. ? 7301, my Administration granted temporary suspension

of portions

of 23 P.S.

? 6311, 35 P.S. ? 872.9a, and 63 P.S. ? 422.33, thereby allowing for the expedited issuance of

temporary licenses to out-of-state practitioners regulated by the Boards of Medicine, Osteopathic

Medicine and Nursing; and

WHEREAS, at my direction, on March 20, 2020, pursuant to 35 Pa. C.S. ? 7301, my Administration granted a temporary suspension of portions of 49 Pa. Code ? 17.3, thereby allowing medical doctors with an institutional license to practice in more than two (2) affiliated facilities and enabling the licensee to practice the full scope of medicine; and

WHEREAS, at my direction, on March 21, 2020 and March 27, 2020, pursuant to 35 Pa. C.S. ? 7301, my Administration granted temporary suspension of certain administrative requirements for the State Board of Nursing, including extension of license expirations dates and waiver of associated fees to ensure that Pennsylvania has as many nurses available as possible; and

WHEREAS, at my direction, on March 22, 2020, pursuant to 35 P.S. ? 7301, my Administration granted temporary suspension of portions of 63 P.S. ? 390-4.1(d), thereby allowing nonresident pharmacies to ship into Pennsylvania without holding a nonresident pharmacy registration; and

WHEREAS, at my direction, on March 22, 2020, pursuant to 35 P.S. ? 7301, my Administration granted temporary suspension of portions of 49 Pa. Code ? 27.12.(b)(2), thereby allowing Pharmacy Technicians to perform limited work remotely under remote supervision by a licensed pharmacist; and

WHEREAS, at my direction, on March 22, 2020, pursuant to 35 P.S. ? 7301, my Administration granted temporary suspension of portions of 63 P.S. ? 390-8(2), thereby allowing out-of-state pharmacists to practice in Pennsylvania during the COVID19 disaster emergency; and

WHEREAS, at my direction, on March 22, 2020, pursuant to 35 P.S. ? 7301, my Administration granted temporary suspension of portions of 63 P.S. ?? 271.10 and 49 Pa. Code ?? 25.162 and 25.175, thereby expanding the scope of practice of physician assistants licensed under the State Board of Osteopathic Medicine to more easily and effectively assist with the disaster emergency response efforts to COVID-19; and

WHEREAS, at my direction, on March 22, 2020, pursuant to 35 P.S. ? 7301, my Administration granted temporary suspension of portions of 63 P.S. ?? 218.2, 218.3 and 49 Pa. Code ?? 21.282a(b), 21.283(a), 21.284(a) and (b) to allow Certified Registered Nurse Practitioners to practice to their full capabilities, including the ability to practice outside their specific clinical specialty as well as the ability to prescribe drugs outside of their established formulary; and

WHEREAS, at my direction, on March 22, 2020 and March 26, 2020, pursuant to 35 P.S. ?

7301, my Administration granted temporary suspension of portions of 49 Pa. Code ??

41.33(a)5), 47.12c(b)(5),

48.13.(b)(5) and

49.13(b)(5),

thereby allowing psychology residents and supervised clinical experience for Social Work,

Marriage and Family Therapy, and Professional Counselors to be completed through electronic

means; and

WHEREAS, at my direction, on March 25, 2020, pursuant to 35 Pa. C.S. ? 7301, to increase

the number of health care practitioners qualified and available to respond to the COVID-

19 disaster emergency and to ensure continuity of patient care and service, my Administration

granted

a

temporary

suspension of portions

of 63

P.S.

?? 18.1(c), 218.5(c)(2), 222(e), 271.10(d) and (f), 271.10b(f), 271.13c(n)(5), 390-3(i) and (j), 390-

3.1, 422.13c(n), 422.36(d), 422.36a(f)(5), 49 Pa. Code ?? 16.15(e)-(h), 1616(c), 16.19(b), 18.145(c),

18.309(a)(1), 18.610(a)(1), 21.29(c)(3), 21.253, 21.271(a) and (b), 21.332a(a), 21.5,

21.29(c)(2), 21.824, 21.828(b), 25.231, 25.163(b), 25.271(c), 25.503, 25.509(c), 21.805, 25.807,

27.31(b) and (d), 27.32, and 27.91, thereby allowing individuals who have inactive, retired or

expired licenses regulated by the Board of Medicine, Board of Osteopathic Medicine, Board of

Nursing and Board of Pharmacy to seek reactivation and immediately resume work within their

scope of practice; and

WHEREAS, at my direction, on March 27, 2020, pursuant to 35 Pa. C.S. ? 7301,

my Administration granted a temporary suspension of portions of 63 P.S. ?? 216, 216(c)(1), 218.2,

218.5(a) and 49 Pa. Code ? 21.17(3) and (5), 21.149(b)(2), 21.155(b) and (d), 21.158, 21.282a(a) and

(b),

21.7(b)(2),

thereby permitting Certified Registered

Nurse

Practitioners to collaborate with all physicians within a hospital system without having to sign a

collaborative agreement with each and every physician, including physicians licensed in other

states. These suspensions also permit Certified Registered Nurse Anesthetists (CRNA) graduates

who have completed an approved anesthesia program to practice without having taken the CRNA

exam under the direction and in the presence of a Board-Certified anesthesiologist; and

WHEREAS, at my direction, on April 7, 2020, pursuant to 35 Pa. C.S. ? 7301, my Administration granted a temporary suspension of 49 Pa. Code ? 17.5(d) and (e), thereby allowing a facility's resident program director to determine which graduate medical trainees have gained the skills and fulfilled the requirements necessary to advance in their postgraduate year (PGY) training in the absence of the United States Medical Licensing Exam; and

WHEREAS, at my direction, on April 7, 2020, pursuant to 35 Pa. C.S. ? 7301, to further increase the number of health care practitioners qualified and available to respond to the COVID-19 disaster emergency and to ensure continuity of patient care and service, my Administration granted a temporary suspension of portions of 63 P.S. ?? 221(c), 1515, 1517 and 49 Pa. Code ?? 21.5, 21.724, 21.725, 40.5, 40.20(c) and (d), 40.191(g), 40.192(b), 40.501, 40.503, 42.16(g), 42.17, 42.53, 45.14(a), thereby allowing individuals who have inactive, retired or expired licenses regulated by the Board of Occupational Therapy, Board of Physical Therapy, Board of Examiners in Speech-Language Pathology and Audiology, and DietitianNutritionists (LDNs) to seek reactivation and immediately resume work within their scope of practice; and

WHEREAS, at my direction, on April 7, 2020, pursuant to 35 Pa. C.S. ? 7301, my Administration granted a temporary suspension of portions of 63 P.S. ?? 1301-1313, 1501-1519, 1708(a), and 49 Pa. Code ?? 40.22, 40.32, 40.51-40.55, 40.161, 40.165, 40.166, 40.17140.173, 40.181, 42.22, 42.23, 45.2, 45.1, 45.14, 45.20 to allow occupational therapists, physical therapists, speech-language pathologists and audiologists to perform skills that they are trained for ? in settings and under circumstances that are outside their normal scope of practice, with less strict adherence to supervision requirements to provide a measure of relief in staffing shortages should they arise throughout the Commonwealth; and

WHEREAS, at my direction, on April 9, 2020, pursuant to 35 Pa.

C.S. ? 7301, my Administration granted a temporary suspension of portions of 63 P.S.

?? 271.13c(j)(1), 422.13c(h)(1)(iii), (h)(3) and (j)(1), and 49 Pa. Code ?? 18.604(d), 18.606(c)

and (d), 25.804(d), 26.806(c) and (d), granting a six-month extension of all Temporary Graduate

Perfusionist

Licenses, and granted a

temporary suspension of 63

P.S. ?? 271,13c(c)(1), 422.13c(j)(1) and 49 Pa. Code ?? 18.606(c) and (d), 25.806(c) and (d),

thereby allowing emergency perfusionists to provide services more than once during a 72-hour

period; and

WHEREAS, at my direction, on April 10, 2020, pursuant to 35 Pa. C.S. ? 7301, my Administration granted a temporary suspension of portions of 49 Pa. Code ? 2712 that allows pharmacy interns who are about to graduate to provide greater levels of assistance with indirect rather than direct supervision by a licensed pharmacist. In addition, my Administration granted a temporary suspension of portions of 63 P.S. ? 3903(e) and 49 Pa. Code ? 27.26(c), thereby extending the six-year time limitation on pharmacy internship certificates; and

WHEREAS, at my direction, on April 10, 2020, pursuant to 35 Pa. C.S. ? 7301, my Administration granted a temporary suspension of any provision of the Pharmacy Act, 63 P.S. ?? 390.1 et seq., and corresponding regulations or Department of State policies that would hinder or impede the ability of pharmacies, pharmacists, interns and pharmacy technicians properly authorized by the Pennsylvania Department of Health and the Centers for Medicare & Medicaid Services (CMS) to test patients for COVID-19 and then report the results directly to the patients; and

WHEREAS, at my direction, on April 10, 2020, pursuant to 35 Pa. C.S. ? 7301, my Administration granted a temporary suspension of portions of 49 Pa. Code ? 27.1 to allow Alternate Care Sites to use a Satellite Pharmacy during the COVID-19 disaster emergency; and

WHEREAS, at my direction, on April 10, 2020, pursuant to 35 Pa. C.S. ? 7301, my Administration granted a temporary suspension of portions of 63 P.S. ? 390-8(2.1)(vi) to allow pharmacists to issue a 30-day emergency supply of nonscheduled legend drugs and schedule V controlled substances. In addition, my Administration granted a temporary suspension of 63 P.S. ? 390-5(a)(8) to allow pharmacists to dispense a 90-day supply of nonscheduled legend drugs at one time by using the refills on the medication; and

WHEREAS, at my direction, on April 10, 2020, pursuant to 35 Pa. C.S. ? 7301, my Administration granted a temporary suspension of portions of 63 P.S. ?? 422.2 and 422.11 to allow medical school students to be used in hospital systems outside of the students' standard course electives in order to gather general information and provide answers to basic questions concerning COVID-19, other general questions about infectious disease control and occasionally patient-specific questions; and

WHEREAS, at my direction, on April 10, 2020, pursuant to 35 Pa. C.S. ? 7301, my Administration granted a temporary suspension of portions of 63 P.S. ?? 42.2, 271.2, 422.2, 625.101-625.1106, and 49 Pa. Code ?? 18.502, 18.509, 25.702, 25.709, 33.208 to provide opportunities to trained health care practitioners, not currently on the front lines of the pandemic response, with the opportunity to assist in response efforts if they so desire. The expansion of the scope of practice of Dentists, Oral Surgeons, Athletic Trainers, Chiropractors and Podiatrists would permit MDs and DOs to delegate certain practices to these practitioners to support the efforts to expand the response needed in hospitals, emergency departments, nursing homes and long-term care facilities during the COVID-19 disaster emergency; and

WHEREAS, at my direction, on April 14, 2020, pursuant to 35 Pa. C.S. ? 7301, my Administration granted a temporary suspension of portions of 63 P.S. ?? 422.2 and 422.11 so that clinical clerk services are not limited to being provided in a hospital and may be more broadly utilized during the COVID-19 disaster emergency; and

WHEREAS, at my direction, on April 16, 2020, pursuant to 35 Pa. C.S. ? 7301, my Administration granted a temporary suspension of portions of 63 P.S. ?? 129, 390-8, 664, and 49 Pa. Code ?? 27.12, 33.101 to provide opportunities to trained health care practitioners and technicians serving in the United States Armed Forces to assist in response efforts to the COVID19 emergency and to augment the healthcare workforce in Pennsylvania; and

WHEREAS, at my direction, on April 17, 2020, pursuant to 35 Pa. C.S. ? 7301, my Administration granted a temporary suspension of portions of 49 Pa. Code ? 17.1 to remove certain administrative requirements that may delay a Graduate Medical

Trainee from obtaining an "interim limited license" (sometimes referred to colloquially as a "moonlighting" license); and

WHEREAS, at my direction, on April 17, 2020, pursuant to 35 Pa. C.S. ? 7301, my

Administration granted a temporary suspension of portions of 63 P.S.

?? 271.10b, 422.13b, 422.36a, 627.5(c), 1306(g),

1309.1(a.1.) and 49

Pa.

Code

?? 18.306, 18.507, 18.705, 18.811, 18.813, 18.821, 18.823, 18.831, 18.841, 20.26(c), 25.506, 25.707,

25.905, 40.22(b), 40.166(d) and (e) to extend temporary licenses and permits that expired or are on

the verge of expiring before the permittee or licensee would have the opportunity to take specific

examinations that have been postponed indefinitely due to COVID-19 related closures of testing

centers/sites; and

WHEREAS, at my direction, on March 17, 2020, pursuant to 35 Pa. C.S. ? 8105(c), the Pennsylvania Department of Health issued EMS Information Bulletin 2020-06 announcing an update to Basic Life Support Protocol #931 regarding aerosol generating procedures and EMS transport to alternate destinations other than a defined receiving facility; and

WHEREAS, at my direction, on March 20, 2020, pursuant to guidance issued by the National Registry of Emergency Medical Technicians, the Pennsylvania Department of Health issued EMS Information Bulletin 2020-07 announcing that any student who successfully completes a Pennsylvania Department of Health approved Emergency Medical Responder, Emergency Medical Technician, Advanced Emergency Medical Technician or Paramedic course will be considered to have met the skills practical examination requirement, and will not have to complete the National Registry of Emergency Medical Technicians' psychomotor exam; and

WHEREAS, at my direction, on March 22, 2020, pursuant to 35 Pa. C.S. ? 7301, the Pennsylvania Department of Health issued EMS Information Bulletin 2020-08 authorizing EMS provider certifications for Emergency Medical Services Vehicle Operators, Emergency Medical Responders, Emergency Medical Technicians, Advance Emergency Medical Technicians, Paramedics, Pre-Hospital Registered Nurses, Pre-Hospital Physician Extenders, Pre-Hospital Emergency Medical Services Physicians and Medical Command Physicians that have expiration dates in March and April 2020 to be extended until July 1, 2020; and

WHEREAS, at my direction, on March 25, 2020, pursuant to 35 Pa. C.S. ? 8129 (r)(2), the Pennsylvania Department of Health issued EMS Information Bulletin 2020-09 authorizing EMS agencies that hold licensure in a state other than the Commonwealth and are requested to respond to an emergency in the Commonwealth , including interfacility transports within the Commonwealth, to do so without obtaining a license issued by the Pennsylvanian Department of Health; and

WHEREAS, at my direction, on March 31, 2020, pursuant to 35 Pa. C.S ? 8116 and 28 Pa. Code ? 1023.26, the Pennsylvania Department of Health issued EMS Information Bulletin 2020-10 clarifying that EMS providers, at or above the level of Advanced Emergency Medical Technician, may obtain and label nasopharyngeal swabs for COVID-19 laboratory analysis; and

WHEREAS, at my direction, on April 1, 2020, pursuant to 35 Pa. C.S. ? 7301, the Pennsylvania Department of Health issued EMS Information Bulletin 2020-11 authorizing Level I staffing exceptions for EMS Vehicle Operators, 35 Pa. C.S. ? 8122; Basic Life Support ambulances, 35 Pa. C.S. ? 8133; Intermediate Advanced Life Support ambulances, 28 Pa. Code ? 1027.34(b), and Advanced Life Support ambulances, 35 Pa. C.S. ? 8130; and

WHEREAS, at my direction, on April 7, 2020, pursuant to 28 Pa. Code ?? 1021(a), (c) and (f), the Pennsylvania Department of Health issued EMS Information Bulletin 2020-14 announcing an exception process allowing expired EMS providers to be reinstated; and

WHEREAS, at my direction, on April 9, 2020, pursuant to 35 Pa. C.S. ? 8105(c), the Pennsylvania Department of Health issued EMS Information Bulletin 2020-17 announcing a statewide basic life support ambulance protocol which permits the non-transport and home care for patients who meet certain criteria, without contact with the EMS agency Medical Command Physician; and

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