On March 17, 2020, Governor Asa Hutchinson issued Executive Order 20-06, ordering state agencies to “identify provisions of any regulatory statute, agency order or rule that in any way prevents, hinders, or delays the agency’s ability to render maximum assistance” to Arkansans during the COVID-19 health emergency. The Order instructed state agencies to identify regulatory statutes, orders, and rules that are hindering or preventing the rapid response necessary to combat the spread of and recovery from COVID-19. The Order requires agencies to identify any such statutes, orders, or rules on its website. Once posted, the statute, rule, or order is deemed suspended for thirty (30) days from the effective date of EO 20-06. On April 13, 2020, Governor Asa Hutchinson issued Executive Order 20-16, extending the suspension until this emergency subsides.
The Secretary of Health has identified certain statutes and rules issued by the Department that he deems a hindrance to mitigating the spread of COVID-19.
They include the following:
Dept of HealthMedical Marijuana patient applicationsArkansas Medical Marijuana Amendment of 2016:
Amendment 98
Extending the expiration dates on cards expiring in the 30 day period until emergency declaration is concluded and crisis passes.
Telehealth for the PWC is temporarily allowed until emergency declaration is concluded
Dept of HealthHome Health Agencies20-10-806 and Rules for Home Health AgenciesSurveys and inspections are temporarily suspended, with the exception of immediate jeopardy complaints:
Suspended RN supervisory visits
Allow extension of current care.
Dept of Health, HospitalTerm: “Physician” is assumed to be that of a medical doctor.
Emergency Definition:
“Physician” means Qualified Medical Professional, working within their scope of practice.
Qualified Medical Professional also includes:
Physician assistant
Nurse practitioner
Clinical nurse specialist
Certified registered nurse anesthetist
Certified nurse-midwife
Clinical social worker
Clinical psychologist
Anesthesiologist’s Assistant
Registered dietician or nutrition professional
Dept of HealthState Hospital RulesThe Medical Staff will be responsible for assuring these professionals provide quality care, they also can approve roles and responsibilities (privileges) to members.
Section 6: Medical Staff
B. Medical Staff Bylaws
1. Medical Staff shall be responsible to the Governing Body of the facility for the quality of medical care provided for patients in the hospital and for the clinical and professional practices of members.Dept of HealthArkansas Rules for Hospitals and Related Institutions, Section 11.E.1There shall be no more beds maintained in the building than the number of beds for which the hospital is licensed except in the case of a public disaster or national emergency and then only as a temporary measure.There is no need to request an increase in licensed beds at this time as we are under a National/State Emergency with the Covid-19 outbreak.Dept. of HealthNewborn Screening Program20-15-301 and Act 113 of 1995CAH programs do not provide direct services for newborn screening or infant hearing. CAH programs oversee the following statutes and rules which require person-to-person contact during service delivery. Each of these services occur following birth of a child where person-to-person contact is required.Dept. of HealthInfant Hearing ProgramAct 1559 of 1999. 20-15-1501CAH programs do not provide direct services for newborn screening or infant hearing. CAH programs oversee the following statutes and rules which require person-to-person contact during service delivery. Each of these services occur following birth of a child where person-to-person contact is required.Dept. of HealthLicensed Lay MidwiferyLLM Rule 302.01Risk Assessments.Dept. of HealthLicensed Lay MidwiferyLLM Rule 302.02Required Antepartum Services at or Near the Initiation of Care.Dept. of HealthLicensed Lay MidwiferyLLM Rule 302.04.01Routine antepartum visits must be made approximately every four (4) weeks during the first 28 weeks of gestation, approximately every two (2) weeks from the 28th to 36th weeks, and weekly thereafter until delivery.Dept. of Health
Licensed Lay Midwifery
LLM Rule 302.05Required Antepartum Services at 24-28 weeksRow►Dept. of Health
Licensed Lay Midwifery
LLM Rule 302.06Required Antepartum Services at 35 to 37 weeksDept. of Health
Licensed Lay Midwifery
LLM Rule 302.07.01Pre-Delivery Home VisitDept. of HealthEmergency Medical ServicesLicensure Renewal ExtendedDept. of HealthEMS/Trauma
Aligning with NREMT and allow for provisional licensure for paramedic, EMT and AEMT licenses. Looking at the data, we will only have 24 paramedic candidates who could be eligible for this provisional certification, provided the students pass the paramedic course and the cognitive exam. We have an additional 118 paramedic candidates that will possibly be eligible by September. With clinical and field internships delayed, these student’s graduation dates may be delayed. While this may not gain a large number of individuals, under these particular circumstances, some may be better than none.
EMS providers that did not recertify within the past 4 years, be looked at for temporary licensure as well. These individuals could not have had their license revoked or suspended by the Agency, but that were in good standing when they relinquished their license. All EMS providers work under the direction of a medical director, EMS agencies could vet these candidates with "temp" licenses and use them should their personnel get ill or are otherwise restricted from work.
Dept. of HealthSECTION IV. GROUND AMBULANCE SERVICE LICENSURE CLASSIFICATION STANDARDS B. 6.
Tiered Response: A licensed ambulance service which has its own dispatch center and uses a dispatch process with certified emergency medical dispatchers that is recognized by the Section and is reliably able to differentiate and categorize the severity of the emergency call may assign the appropriate level of ambulance to that call. Services utilizing a tiered response dispatch process shall meet the following provisions:
a. The emergency call must be answered and screened by a certified Emergency Medical Dispatcher (EMD). EMD Certification must be obtained and maintained by a National Recognized Certifying body that is recognized by the Section of EMS.
b. The EMD Center must have Medical Direction oversight.
c. The service shall be required to have a quality assurance program in place to insure compliance with their service protocols and shall be reviewed by the Medical Director within 30 days of the call date.
d. All tiered responses that require a higher level intercept shall be tracked separately and reported to the section on a quarterly basis.
e. The service shall have a process in place that would specifically and reliably identify which calls are appropriate for less than the highest level of permitted ambulance and track all calls in which this dispatch process is implemented.
f. All requirements are met for the ambulance that is responding for equipment, personnel and licensure standards set forth in regulation.
Dept. of HealthSECTION IV. GROUND AMBULANCE SERVICE LICENSURE CLASSIFICATION STANDARDS A. 2 -4
2. Licensed Paramedic Services shall have fifty percent (50%) or more ambulances permitted at the Paramedic level. Only licensed Paramedic Services may operate Paramedic ambulances.
3. Licensed Advanced EMT Services shall have fifty percent (50%) or more ambulances permitted at the Advanced EMT level. Only Advanced EMT and Paramedic Services may operate Advanced EMT ambulances.
4. Licensed EMT Services shall have ambulances permitted only at the EMT level. Paramedic and Advanced EMT Services may also operate EMT ambulances.
Dept. of HealthD. Specific Standards 1. B., 3. B., 4. B., 5.B.Temporary Rule to Implement:
Remove the 2-minute reaction time. This will also for proper triage and screening to ensure the protection of the responding providers and allow for proper PPE to be used and ambulance to be configured if needed.Dept. of HealthSECTION V. PERMITTING OF GROUND EMERGENCY VEHICLES B. Vehicle General Standards 5., 9., 10
5. New ambulances replacing a permitted vehicle or being added to an existing service license must be inspected and permitted prior to being placed in service.
9. Only ambulances of a Paramedic or Advanced EMT Service shall be equipped with ALS Equipment unless a prior request for an upgrade has been made and approved by the department.
10. Temporary upgrades and downgrades of permitted ambulances are for mechanical reasons only and must be for a temporary period of time. Notice shall be made in writing on approved forms to the Department prior to any changes in equipment or staffing of permitted ambulances. Upgrades and downgrades are not permitted for the purposes of staffing. Permanent upgrades and downgrades shall follow the same guidelines as a new vehicle permit.
Dept. of HealthSECTION V. PERMITTING OF GROUND EMERGENCY VEHICLES C. Ambulance Staffing Requirements 1-7Temporary Rule to Implement:
Allow ambulance services to staff their ambulance with the highest trained personnel available to respond for service. This may include adding physicians, nurses, or other licensed healthcare providers.
Allow ambulance services to staff their ambulance with a driver who is not currently licensed as an EMS provider.Dept. of HealthSECTION IX. EDUCATION, TESTING AND LICENSURE OF PERSONNEL B. 5.Emergency Vehicle Operator: a. Successful completion of a National recognized First Responder Course of a minimum of 40 hours of training. b. Copy of a current signed Healthcare Provider CPR card (Must follow current American Heart Association Guidelines and require a hands on skills component) documenting completion of a CPR course designed specifically for healthcare providers. c. Emergency Vehicle Operator Course d. 10 hours of refresher training every two years to include emergency vehicle operations.Dept. of HealthSECTION IX. EDUCATION, TESTING AND LICENSURE OF PERSONNEL C. 1-2Directive already issued to extend relicensure deadline to June 30, 2020 See directive at https://www.healthy.arkansas.gov/images/uploads/pdf/license_renewal_extension.pdf.Dept. of HealthOther Suggestions
Mechanisms for temporary licensure of EMS providers who have lapsed licensure within the past 5 years. We could modify licensure and credentialing procedures to meet the exigencies of the situation while assuring public health and safety.
The state could implement a just-in-time training program, combined with appropriate and coordinated information to the EMS medical directors and EMS providers, that will help to ensure appropriate and competent medical care.
All EMS providers to include points of referral for patients who need information but do not need emergency care or transport. Allow EMS Services to not transport patients that would not need emergency transport, but provide information of health alternatives, or connect them to a COVID evaluation hotline. the appropriate care may be to have individuals stay at home and practice social distancing and quarantine measures rather than be transported to a healthcare facility.
EMS Treat and Release - Community containment strategies designed to limit the spread of the virus may require patients be treated and released without transport. Additionally, healthcare facilities may become overwhelmed with patients, making it necessary to consider alternative options for patients who can be safely treated without transport.
If a treatment without transport role is deemed appropriate for EMS providers, the EMS medical director, in coordination with local public health authorities, should establish criteria and reporting requirements.
“Treat and release” and “treatment without transport” protocols require oversight by EMS medical directors.
EMS agencies and EMS medical directors should coordinate with the local public health authorities to pre-determine the destination of both suspected COVID-19 and positive COVID-19.
Appropriate education programs for EMS personnel, physicians, and the public should be established before the implementation of non-transport policies.
Dept. of Health Rules pertaining to Tuberculosis (2020)Temporarily suspending baseline screening for health care workers and long-term care