Massachusetts continues to issue directives and guidance for health care providers in response to COVID-19. In this post we highlight Orders and Guidance issued by Massachusetts Governor Baker and the Massachusetts Department of Public Health (DPH). The guidance addresses topics including collection of COVID-19 demographic information, use of alternative space for provision of health care treatment, health professional licensing, EMS transport of patients, hospital policies for returning exposed health care personnel to work, use of PPE and equipment, and updates for pharmacies.
Collection of Demographic Information
On April 8, DPH issued an emergency Order regarding collection of complete demographic information on patients with confirmed or suspected COVID-19. The order provides that health care providers “shall make every reasonable effort to collect complete demographic information, including full name, date of birth, sex, race and ethnicity, address, and telephone number on patients with confirmed or suspected COVID-19, and must include such information collected when ordering a laboratory test for the disease. Laboratories conducting tests for COVID-19 shall report demographic information received from providers in accordance with 105 CMR 300.170.” DPH was directed to issue additional guidance to implement this Order.
Use of Unlicensed and Alternative Space for Inpatient and Ambulatory Care
On April 3, DPH released two guidance documents informing hospitals of ways they can use unlicensed and alternative space to expand capacity to respond to the COVID-19 pandemic. DPH’s Guidance Regarding Implementation of Alternative Acute Care Space during the COVID-19 State of Emergency expands earlier guidance for hospitals on utilizing alternative unlicensed space for inpatient care during the COVID-19 state of emergency. Earlier DPH guidance issued on March 22 allowed hospitals without sufficient acute inpatient beds to provide care in space appropriate for inpatient care, including but not limited to: post-anesthesia care unit beds, beds out of service, and inpatient rehabilitation units. Under the new guidance, DPH clarifies that hospitals may add beds to spaces that are unlicensed, whether on or off the hospital’s main campus, including spaces not owned by the hospital. Such expansion must comply with requirements listed on Attachment A of the new guidance document. DPH notes that in addition to meeting the requirements of Attachment A, hospitals must complete an attestation form also included in the guidance and email or fax it to DPH prior to opening the space. DPH further notes, “this memo DOES authorize a hospital to establish beds or units in buildings that are not currently licensed for hospital services. DPH is NOT requiring the hospitals to request licenses for units in buildings that are not currently licensed for hospital services during the COVID19 2020 state of emergency.”
DPH’s Authorization and Guidelines for Use of Alternate Space for Treatment of Patients during the COVID-19 State of Emergency updates earlier guidance issued March 6, and informs hospitals on using alternative unlicensed space for treatment of ambulatory patients presenting with possible COVID-19. Stating that DPH has received requests from hospitals to use space not currently licensed or approved for patient care, on or off the hospital campus, to temporarily establish alternative care areas for the screening, evaluation and treatment of patients, the guidance allows hospitals to “identify and use existing non-patient care space, or other outpatient or inpatient care space, or other unlicensed space not on the hospital’s campus” as needed for patient care and consistent with enclosed guidelines. The referenced guidelines are not provided within or linked within the document, however, a version appears in the earlier guidance. The hospital must also sign a Letter of Attestation in lieu of an onsite survey prior to opening the space. Apart from documentation specifically required in the Attestation, DPH is not requiring hospitals to submit supportive documentation of their written plan for use of alternate space.
Health Professional Licensure
On April 9, Governor Baker issued two emergency orders to further support the health care workforce and expand its capacity. First, the Order Providing Accelerated Licensing of Physicians Educated in Foreign Medical Schools directs the Board of Registration in Medicine (BORM) to provide expedited licensure of physicians who have graduated from international medical schools, are currently practicing in a US jurisdiction with a limited license, and have completed at least 2 years of postgraduate medical training in an approved program. The BORM was directed to issue further guidance to implement this.
Further, the Order Authorizing Nursing Practice by Graduates and Senior Students of Nursing Education Programs exempts certain nursing school graduates and almost-graduates from the prohibition against the unlicensed practice of nursing at M.G.L. ch 112 §§ 80, 80A, and 80B provided that such individuals are currently employed by or providing health care services at the direction of a licensed facility or provider, are directly supervised while providing health care services, and the health care services are provided in response to COVID-19. The employing licensed facility or provider must also verify the individual’s academic credentials required under the order. The Board of Registration in Nursing (BORN) was directed to issue additional guidance to implement this.
On April 3, DPH issued an Order Rescinding and Replacing the March 29, 2020 Order Maximizing Health Care Provider Availability expanding the availability of certain health care providers. The Order provides for reciprocal expedited licensing for providers licensed and in good standing in other jurisdictions, and renewal of expired licenses. The Order applies to health care providers including: a registered nurse, licensed practical nurse, advanced practice registered nurse, dentist, dental hygienist, dental assistant, pharmacist, pharmacy technician, nursing home administrator, physician assistant, respiratory therapist, perfusionist, genetic counselor, community health worker, emergency medical technician, social worker, psychologist, marriage and family therapist, licensed mental health counselor, rehabilitation counselor, applied behavior analyst, assistant behavior analyst, licensed school psychologist, licensed alcohol and drug counselor, radiologic technologist, radiologist assistant, and nuclear medicine advanced associate.
Pursuant to the above Order, the DPH Bureau of Health Professions Licensure issued Guidance on Licensing Changes during State of Emergency. The Guidance does not fully track the Order, providing that only the following types of health care providers are eligible for (i) emergency reciprocal licensure, (ii) renewal of previously expired licenses, and (iii) protections related to providing telemedicine services in Massachusetts: registered nurses, licensed practical nurses, advanced practice registered nurses, dentists, dental hygienists, dental assistants, pharmacists, pharmacy technicians, nursing home administrators, physician assistants, respiratory therapists, perfusionists, genetic counselors, and community health workers. However, extension of license expiration is available to all license types issued by Massachusetts Boards of Registration within the Bureau of Health Professions Licensure.
Health Care Personnel, PPE, and Equipment
On April 5, DPH issued updated guidance on Comprehensive Personal Protective Equipment (PPE). This includes DPH’s updated guidance for use of PPE by health care professionals.
On April 2, DPH issued Revised Guidance for Allowing Asymptomatic Health Care Personnel and Emergency Medical Technicians to Work Following a Known Exposure to COVID-19. The guidance describes procedures hospitals are required to take before allowing healthcare personnel to work after exposure.
On April 2, DPH issued a guidance memo related to Integrating Anesthesia Staff and Anesthesia Machines into COVID-19 Intensive Care Work Streams. The guidance encourages hospitals to immediately identify any anesthesia ventilators, transport ventilators, and non-invasive ventilators in their organizations that can potentially be used for COVID-19 clinical management, ensure they are in proper working order, ensure they are available to use for the care of patients who need ventilator support, and ensure there are adequately trained staff to operate these resources. The memorandum provides links to additional industry and administrative guidance regarding the use of ventilators.
On April 3, the DPH Office of Emergency Medical Services (OEMS) issued a Waiver for EMS Transport of Emergency Patients in Impending Childbirth or with Pregnancy Complications to Designated Alternate Sites on Hospital Grounds. Suspending certain provisions of the Emergency Medical Services (EMS) System Regulations at 105 CMR 170.000, the Waiver provides that EMS may bring patients in impending childbirth, or with pregnancy complications, by ambulance directly to a labor and delivery department, or other alternate site designated by the hospital on its grounds for such patients, instead of to the hospital’s emergency department. “Appropriate Healthcare facility” defined in the EMS Regulations at 105 CMR 170.020 is revised to mean “An emergency department, either physically located within an acute care hospital license by the Department pursuant to 105 CMR 130.000 to provide emergency services, or in a satellite emergency facility approved by the Department pursuant to 130.821, or an alternate site on the hospital’s grounds, designated by the acute care hospital, for the reception of emergency patients in impending childbirth or pregnancy complications, that is closest geographically or conforms to a Department-approved point of entry plan.”
On March 29, OEMS issued a Temporary Waiver for Non-Transport of Certain COVID-19-Only Patients. The waiver suspends certain provisions of the EMS System Regulations, and is intended to alleviate hospital overcrowding and potential EMS personnel staffing shortages due to COVID-19. The waiver allows EMS to assess and leave patients who are presumed to be infected with COVID-19 and have no other complaints at their residences for self-care, rather than transport them to the hospital, in accordance with a temporary emergency Statewide Treatment Protocol issued for this purpose, for the duration of the State of Emergency declared by the Governor for COVID-19. Under the Waiver, 105 CMR 170.355 Responsibility to Dispatch, Treat and Transport is revised to allow EMS to refuse to transport a patient to an appropriate health care facility, if the patient is assessed to fit the criteria under emergency Statewide Treatment Protocols for COVID-19 emergency non-transport.
On April 4, DPH issued an emergency Order regarding a COVID Pharmacy Assistance Team. Under the Order, a “COVID Pharmacy Assistance Team, comprised of clinicians and other healthcare professionals employed or contracted by the Commonwealth, and under the direction of MassHealth, hereby has the authority to request prescription refills, transfer prescriptions, discuss medications lists and prescription history with providers and pharmacies, and facilitate the dispensing and delivery of medications on behalf of quarantined individuals in the Commonwealth. Pharmacies and providers shall treat requests from the COVID Pharmacy Assistance Team on behalf of a quarantined individual as if they were made directly by the quarantined individual.”