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COVID-19 Actions - Regulatory Waivers

As of March 26, 2020

Suspension of State Statutes

Comprehensive Care Facilities (Nursing Homes)

EXECUTIVE ORDER 20-05

Ind. Code 16-29-7 – The State Health Commissioner is authorized to waive the requirements of the nursing home certificate of need statute, as the Commissioner deems necessary to respond to COVID-19 issues for nursing homes and on terms and conditions appropriate for each situation. 

EXECUTIVE ORDER 20-12 

Ind. Code 16-41-8-1 – Waives the provisions restriction release of communicable disease information ISDH receives to the extent necessary to allow COVID-19 information to be submitted to the Indiana Network for Patient Care to perform research on COVID-19 for the ISDH.

Waivers of State Rules

Comprehensive Care Facilities (Nursing Homes)

EXECUTIVE ORDER 20-05

410 IAC 16.2-3.1-12(a)(13) – waives the requirement that resident appeals of transfer and discharge be held at the healthcare facility. 

INDIANA’S SECTION 1135 CMS WAIVER: Approved 03/25/2020

  • Suspends Pre-Admission Screening and Annual Resident Review (PASRR) Level I and Level II Assessments for 30 days (period may be extended). Facilitates waiver of parallel state rule.
  • Waives requirement that Medicaid/Medicare patients must be in Medicaid/Medicare approved beds or locations to qualify for reimbursement. Facilitates waiver of certain state rules requiring approvals of bed changes and patient relocation.

EMERGENCY ORDER AUTHORIZING TEMPORARY PERSONAL CARE ATTENDANT POSITIONS AND TRAINING FOR NURSING HOMES:  Issued 03/21/2020, retroactive to 03/06/2020

  • 410 IAC 16.2-3.1-14 and 410 IAC 16.2-3.1-18 – allows nursing homes to train and utilize temporary Personal Care Attendants (“PCAs”) to perform lower-level, non-clinical duties.  

EMERGENCY ORDER GRANTING TEMPORARY BLANKET WAIVERS FOR COMPREHENSIVE CARE FACILITIES: Issued 03/20/2020, retroactive to 03/06/2020

  • 410 IAC 16.2-3.1-14(t)(1) – waives pre-employment tuberculosis testing for personnel and gives the facility ninety (90) days after start of employment to complete the testing.
  • 410 IAC 16.2-3.1-18(c) – waives a requirement for each resident to have received a diagnostic chest x-ray in the last six months.
  • 410 IAC 16.2-3.1-18(e) – waives and modifies the tuberculosis testing for residents to allow it to be completed within 90 days of admission.

SECOND EMERGENCY ORDER GRANTING TEMPORARY BLANKET WAIVERS FOR COMPREHENSIVE CARE FACILITIES: Issued 03/21/2020, retroactive to 03/06/2020

  • 410 IAC 16.2-3.1-10 – waives living arrangement requirements to allow for more rapid resident moves as needed.
  • 410 IAC 16.2-3.1-12(a)(7) – replaces the 30 day requirement for most notices of involuntary transfer or discharge with an “as soon as practicable” standard
  • 410 IAC 16.2-3.1-14(b) – extends from four (4) to eight (8) months the period of time a facility may use a trained-but-not-yet tested certified nurse aide.
  • 410 IAC 16.2-1-14(c)(1) – extends the deadline for certified nurse aides to complete in-facility training from 120 to 240 days after the start of employment.
  • 410 IAC 16.2-3.1-22(d) – waives in-person physician visit schedules to allow for telemedicine and other means of contact (no relaxation of applicable duty or standard of care).
  • 410 IAC 16.2-3.1-33(b)(1)-(7) and (9) – waives assorted group and outside activities usually required in a facility’s plan of activities for residents.
  • 410 IAC 16.2-3.1-53 – allows individuals to provide limited dining assistance if given specified training.

THIRD EMERGENCY ORDER GRANTING TEMPORARY BLANKET WAIVERS FOR COMPREHENSIVE CARE FACILITIES: Issued 03/23/2020, retroactive to 03/06/2020

  • 410 IAC 16.2-3.1-14(t) – waives the requirement that each employee must have a physical examination within one (1) month after start of employment

FOURTH EMERGENCY ORDER GRANTING TEMPORARY BLANKET WAIVERS FOR COMPREHENSIVE CARE FACILITIES:  Issued 03/26/2020 

  • Section 1135 Waiver granted to Indiana on March 25, 2020 – Permits any comprehensive care facilities that has declared a COVID-19 facility emergency and notified ISDH of the declaration may render care in any bed or room within the facility regardless of its certification or approval for a particular category of residents or reimbursement and render care to a residence relocated to an unlicensed space within the facility or to a different facility not licensed to provide skilled nursing care provide notice of full detains are provided to ISDH; resident’s care and safety needs are met; and ISDH is notified of residents return to prior room or different room in its licensed space.
  • 410 IAC 16.2-3.1-2(d) and (e) – waives portions related to remodels, structural changes and bed changes for any comprehensive care facility that has declared a COVID-19 facility emergency and notified ISDH of the declaration if done in accordance with the guidelines set forth in the Fourth Emergency Order.
  • Permits an existing facility to relocate, convert, and reclassify beds and renumber rooms if done in accordance with the guidelines set forth in the Fourth Emergency Order.
  • 410 IAC 16.2-3.1-8 – Waives access and visitation rights standards to the extent necessary to be accordance with guidance by the Centers for Medicare & Medicaid Services (“CMS”), ISDH and /or by an Executive Order of the Governor of Indiana.

AMENDMENT OF EMERGENCY ORDER AUTHORIZING TEMPORARY PERSONAL CARE ATTENDANT POSITIONS AND TRAINING FOR NURSING HOMES: Issued 04/02/2020, effective 03/16/20 through 05/01/2020

  • Permits minors age 16 and 17 to be eligible for training and work as Personal Care Attendants (“PCAs”).

FIFTH EMERGENCY ORDER GRANTING TEMPORARY BLANKET WAIVERS FOR COMPREHENSIVE CARE FACILITIES: Issued 04/02/2020, retroactive to 03/06/2020 

  • Waives the following requirements and procedures for resident transfers and discharges subject to the terms forth in the Order:
    • 410 IAC 16.2-3.1-12(a)(4)(A) is waived and modified in the matter outlined.
    • 410 IAC 16.2-3.1-12(a)(8)(D) is waived and modified in the matter outlined.
    • 410 IAC 16.2-3.1-12(a)(9)(D) is waived and modified in the matter outlined.
    • 410 IAC 16.2-3.1-12(a)(13) is waived and modified in the matter outlined.
    • 410 IAC 16.2-3.1-12(a)(14) is waived and modified in the matter outlined.
    • 410 IAC 16.2-3.1-12(a)(15) is waived and modified in the matter outlined.
    • 410 IAC 16.2-3.1-12(a)(18) is waived and modified in the matter outlined.

THIRD EMERGENCY ORDER CONCERNING TEMPORARY PERSONAL CARE ATTENDANTS FOR NURSING HOMES:  Issued 04/08/2020, effective indefinitely:

  • Permits minors age 16 and 17 to be eligible for training and work as Personal Care Attendants (“PCAs”).  Supersedes order dated 04/02/2020.

SIXTH EMERGENCY ORDER GRANTING TEMPORARY BLANKET WAIVERS FOR COMPREHENSIVE CARE FACILITIES: Issued 04/18/2020, retroactive to 03/06/2020:

  • Temporarily approves the “Temporary Nurse Aide Program” offered by the American Health Care Association (“AHCA”) and the National Center for Assisted Living (“NACL”).
  • 410 IAC 16.2-3.1-14(c), setting forth the requirements for certified nurse aide (“CNA”) training programs is waived. 
  • Permits former CNA’s whose certifications expired or lapsed to be utilized as temporary CNAs under certain conditions.
  • Permits facilities to request approval on a cases by case basis to temporarily use former CNAs who do not precisely meet conditions set forth in the waiver by demonstrating the CNA’s competency to ISDH in the manner outlined.
     

Residential Care Facilities (Licensed Assisted Living)

EXECUTIVE ORDER 20-05

  • 410 IAC 16.2-5-1.2(r)(7) – waives the requirement that resident appeals of transfer and discharge be held at the healthcare facility. 

EMERGENCY ORDER AUTHORIZING TEMPORARY PERSONAL CARE ATTENDANT POSITIONS & TRAINING FOR RESIDENTIAL CARE FACILITIES: Issued 03/23/2020, retroactive to 03/06/2020

  • 410 IAC 16.2-3.1-14 and 410 IAC 16.2-3.1-18 – allows residential care facilities to train and utilize temporary Personal Care Attendants (“PCAs”) to perform lower-level, non-clinical duties.

EMERGENCY ORDER GRANTING TEMPORARY BLANKET WAIVERS FOR RESIDENTIAL CARE FACILITIES: Issued 03/20/2020, retroactive to 03/06/2020

  • 410 IAC 16.2-5-1.4(f)(1) – waives and modifies the requirements for tuberculosis testing for personnel at nursing homes giving 90 days from start of employment to complete the screening.
  • 410 IAC 16.2-5-12(c) – waives a requirement for diagnostic chest x-ray in the last six months.
  • 410 IAC 16.2-5-12(e) – waives and modifies the tuberculosis testing for residents to allow it to be completed within 90 days of admission.

SECOND EMERGENCY ORDER GRANTING TEMPORARY BLANKET WAIVERS FOR RESIDENTIAL CARE FACILITIES:  Issued 03/21/2020, retroactive to 03/06/2020

  • 410 IAC 16.2-5-1.2(r)(7) and 410 IAC 16.2-5-1.2((r)(6) – replaces the 30 day requirement for most notices of involuntary transfer or discharge with an “as soon as practicable” standard
  • 410-IAC-16.2-5-4(e) – permits preparation of medication doses for residents on a weekly basis (instead of daily) using a pill planner or similar device.

THIRD EMERGENCY ORDER GRANTING TEMPORARY BLANKET WAIVERS FOR RESIDENTIAL CARE FACILITIES:  Issued 03/23/2020, retroactive to 03/06/2020

  • 410 IAC 16.2-5-13 – allows individuals to provide limited dining assistance if given specified training.
  • 410 IAC 16.2-5-7.1(b) – waives the requirement for providing and/or coordinating scheduled transportation to scheduled community based activities.

AMENDMENT OF EMERGENCY ORDER AUTHORIZING TEMPORARY PERSONAL CARE ATTENDANT POSITIONS AND TRAINING FOR RESIDENTIAL CARE FACILITIES: Issued 04/02/2020, effective 03/16/20 through 05/01/2020

  • Permits minors age 16 and 17 to be eligible for training and work as Personal Care Attendants (“PCAs”).

FOURTH EMERGENCY ORDER GRANTING TEMPORARY BLANKET WAIVERS FOR RESIDENTIAL CARE FACILITIES:  Issued 04/02/2020, retroactive to 03/06/2020

  • 410 IAC 16.2-5-1.2(o) and (bb) – (ff) (“Residents’ Rights) – waived to the full extent necessary to be in compliance with all applicable restrictions and limitations from CMS, ISDH, and/or the Governor of Indiana through Executive Order.
  • 410 IAC 16.2-5-1.4(f) – Requirement of an immediate health care screen for each employee is waived to permit the required screen to occur within ninety (90) days after start of employment.
  • 410 IAC 16.2-5-1.1(d) and (e) relating to remodels, structural changes and bed changes, are waived for any residential care facility that has (1) declared a COVID-19 facility emergency and (2) notifies ISDH of changes in the manner outlined.
  • 410 IAC 16.2-5-1.2(r)(4)(A) is waived and modified in the manner outlined.
  • 410 IAC 16.2-5-1.2(r)(8)(D) is waived and modified in the manner outlined.
  • 410 IAC 16.2-5-1.2(r)(9)(D) is waived and modified in the manner outlined.
  • 410 IAC 16.2-5-1.2(r)(13) is waived and modified in the manner outlined.
  • 410 IAC 16.2-5-1.2(r)(14) is waived and modified in the manner outlined.
  • 410 IAC 16.2-5-1.2(r)(15) is waived and modified in the manner outlined.
  • 410 IAC 16.2-5-1.2(r)(18) is waived and modified in the manner outlined.

THIRD EMERGENCY ORDER CONCERNING TEMPORARY PERSONAL CARE ATTENDANTS FOR RESIDENTIAL CARE FACILITIES:  Issued 04/08/2020, effective indefinitely:

  • Permits minors age 16 and 17 to be eligible for training and work as Personal Care Attendants (“PCAs”).  Supersedes order dated 04/02/2020.

FIFTH EMERGENCY ORDER GRANTING TEMPORARY BLANKET WAIVERS FOR RESIDENTIAL CARE FACILITIES: Issued 04/20/2020, retroactive to 03/06/2020:

  • Temporarily approves the “Temporary Nurse Aide Program” offered by the American Health Care Association (“AHCA”) and the National Center for Assisted Living (“NACL”).
  • Permits former CNA’s whose certifications expired or lapsed to be utilized as temporary CNAs under certain conditions.
  • Permits facilities to request approval on a cases by case basis to temporarily use former CNAs who do not precisely meet conditions set forth in the waiver by demonstrating the CNA’s competency to ISDH in the manner outlined.

Hospitals

INDIANA’S SECTION 1135 CMS WAIVER: Approved 03/15/2020

  • Waives requirement that Medicaid/Medicare patients must be in Medicaid/Medicare approved beds or locations to qualify for reimbursement. Facilitates waiver of certain state rules requiring approvals of bed changes and patient relocation.

COVID-19 NATIONAL/STATE EMERGENCY HOSPITAL BLANKET WAIVER: CONVERSION OF STANDARD PATIENT ROOMS TO NEGATIVE PRESSURE ISOLATION ROOMS:  Issued 3/21/2020, amended 3/22/2020, retroactive to 03/06/2020

  • Waives requirement of pre-approval for hospitals converting non-isolation rooms to isolation rooms, so long as they send notice to ISDH and request an inspection.

SECOND COVID -19 NATIONAL/STATE EMERGENCY HOSPITAL BLANKET WAIVER: PATIENT ROOMS: Issued 03/24/2020, retroactive to 03/06/2020

  • Waives requirement of pre-approval for hospitals converting unused or unlicensed space to temporary patient rooms. Specifies that room and units previously approved but not in current use may be operationalized without review or inspection.

THIRD COVID-19 NATIONAL/STATE HOSPITAL BLANKET WAIVER: PERMITTING CERTAIN REMODEL, RENOVATION, CONVERSION, REPURPOSING, ADDITION AND OTHER PHYSICAL OR STRUCURAL CHANGE:  Issued March 27, 2020, retroactive to 03/06/2020 

  • Waives certain requirements for a Hospital that has declared a COVID-19 Emergency and notified ISDH of said declaration.  Sets forth requirements that are waived, and those that will not be waived, and sets forth maximum time for which a temporary improvement shall be removed and time to request approval of permanent improvement.  

AMENDMENT OF EMERGENCY ORDER AUTHORIZING TEMPORARY PERSONAL CARE ATTENDANT POSITIONS AND TRAINING FOR RESIDENTIAL CARE FACILITIES: Issued 04/02/2020, effective 03/16/20 through 05/01/2020

  • Permits minors age 16 and 17 to be eligible for training and work as Personal Care Attendants (“PCAs”).

FOURTH EMERGENCY ORDER GRANTING TEMPORARY BLANKET WAIVERS FOR RESIDENTIAL CARE FACILITIES:  Issued 04/02/2020, retroactive to 03/06/2020

  • 410 IAC 16.2-5-1.2(o) and (bb) – (ff) (“Residents’ Rights) – waived to the full extent necessary to be in compliance with all applicable restrictions and limitations from CMS, ISDH, and/or the Governor of Indiana through Executive Order.
  • 410 IAC 16.2-5-1.4(f) – Requirement of an immediate health care screen for each employee is waived to permit the required screen to occur within ninety (90) days after start of employment.
  • 410 IAC 16.2-5-1.1(d) and (e) relating to remodels, structural changes and bed changes, are waived for any residential care facility that has (1) declared a COVID-19 facility emergency and (2) notifies ISDH of changes in the manner outlined.
  • 410 IAC 16.2-5-1.2(r)(4)(A) is waived and modified in the manner outlined.
  • 410 IAC 16.2-5-1.2(r)(8)(D) is waived and modified in the manner outlined.
  • 410 IAC 16.2-5-1.2(r)(9)(D) is waived and modified in the manner outlined.
  • 410 IAC 16.2-5-1.2(r)(13) is waived and modified in the manner outlined.
  • 410 IAC 16.2-5-1.2(r)(14) is waived and modified in the manner outlined.
  • 410 IAC 16.2-5-1.2(r)(15) is waived and modified in the manner outlined.
  • 410 IAC 16.2-5-1.2(r)(18) is waived and modified in the manner outlined.

Home Health Agencies

EMERGENCY ORDER GRANTING TEMPORARY BLANKET WAIVERS FOR HOME HEALTH AGENCIES (CORRECTED):  Issued: 04/14/2020; retroactive to 03/06/2020

  • 410 IAC 17-9-19 is waived with modification to permit a “medical plan of care” to include written instructions signed by a physician assistant, nurse practitioner, or clinical nurse specialist.
  • 410 IAC 17-12-1(h) is waived as to requirements for employee physical examinations.
  • 410 IAC 17-12-1(i)(6) is waived as to requirements for documentation of employee tuberculosis exams.
  • 410 IAC 17-12-2(d) is waived with modification to permit an initial assessment to occur remotely or via file review.
  • 410 IAC 17-12-3(a)(1)(B) is waived with modification to permit the patients written notice of the patient's rights to be given as part of the initial assessment of the patient’s needs before the initiation of treatment.
  • 410 IAC 17-12-3(d) is waived as to the requirement of furnishing a patient a listing of all individuals or legal entities having an ownership or interest in the agency.
  • 410 IAC 17-13-1(a) is waived with modification to permit a “Medical plan of care” to be periodically reviewed by a physician assistant, nurse practitioner, or clinical nurse specialist.
  • 410 IAC 17-13-1(a)(2) is waived with modification to permit a the medical plan of care to be periodically reviewed by a physician assistant, nurse practitioner, or clinical nurse specialist and for the written summary report for each patient to be sent to a physician assistant, nurse practitioner, clinical nurse specialist, dentist, chiropractor, optometrist or podiatrist.
  • 410 IAC 17-13-1(b) is waived with modification to permit a Home Health Agency to accept written orders for home health services from a physician assistant, nurse practitioner, or clinical nurse specialist.
  • 410 IAC 17-13-1(c) is waived with modification to include order for home health services from a physician assistant, nurse practitioner, or clinical nurse specialist.
  • 410 IAC 17-13-2(b)(7) is waived with modification to permit supervisory visits to occur through telehealth if clinically appropriate.
  • 410 IAC 17-14-1(a)(1)(H) and (I) are waived with modification to include physician assistants, nurse practitioners, or clinical nurse specialists.
  • 410 IAC 17-14-1(a)(2)(F) and (G) are waived with modification to include physician assistants, nurse practitioners, or clinical nurse specialists.
  • 410 IAC 17-14-1(c)(3) is waived with modification to include physician assistants, nurse practitioners, or clinical nurse specialists.
  • 410 IAC 17-14-1(h) is waived with modification to reduce home health aide continuing education hours to one hour per month after expiration of Governor’s emergency declaration for remainder of 2020. 
  • 410 IAC 17-14-1(n) is waived with modification to permit supervisory visits to occur through telehealth if clinically appropriate.
  • 410 IAC 17-14-1(a)(1)(A) is waived with modification to permit the initial evaluation visit to occur through telehealth if clinically appropriate.
  • 410 IAC 17-14-1(e) is waived with modification to permit social services to occur through telehealth if clinically appropriate.
  • 410 IAC 17-15-1(a)(2) and (4) is waived with modification to include physician assistants, nurse practitioners, or clinical nurse specialists and to require clinical notes to be written within 48 hours and incorporated within 30 days of the time service is rendered.

Women, Infant & Children (“WIC”)

Physical Presence Waiver:  Waives the physical presence requirements set forth in 42 U.S.C. 1786(d)(3)(C)(i) and includes the ability to defer anthropometric and bloodwork requirements to determine nutritional risk for the period the physical presence waiver is in effect per section2203(a)(1)(B) or H.R. 6201.

Issuance of Benefits and In Person Pick up Waiver: Waives the requirements of 7 CFR 246.12(r)(4) requiring in-person pick of food instruments when a participant is scheduled for nutrition education or has a subsequent certification appointment and allows Indiana WIC to remotely issue benefits to any participant.

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This site was last updated 6/01/2020 4:50 PM