New York Codes, Rules and Regulations › Title 9 - EXECUTIVE DEPARTMENT › Subtitle A - Governor's Office › Chapter I - Executive Orders › Part 9 - Executive Orders (Kathy Hochul) › Section 9.20 - Executive Order No. 20: Declaring a Statewide Disaster Emergency Due to Healthcare Staffing Shortages in the State of New York

Current through Register Vol. 46, No. 28, July 10, 2024
WHEREAS, the current staffing shortages in hospital and
					 other healthcare facilities are. expected to impact availability of care,
					 threatening public health and safety;
WHEREAS, severe understaffing in hospitals and other
					 healthcare facilities is expected to effect the ability to provide critical
					 care and to adequately serve vulnerable populations;
WHEREAS, there is an immediate and critical need to
					 supplement staffing to assure healthcare facilities can provide care;
NOW, THEREFORE, I, Kathy Hochul, Governor of the State of
					 New York, by virtue of the authority vested in me by the Constitution and the
					 Laws of the State of New York, do hereby find, pursuant to Section 28 of
					 Article 2-B of the Executive Law, that a disaster is imminent in New York
					 State, for which the affected local governments are unable to respond
					 adequately, and I do hereby declare a Statewide disaster emergency for the
					 entire State of New York. This Executive Order shall be in effect for thirty
					 days froth the date of this Executive Order; and
FURTHER, pursuant to Section 29 of article 2-B of the
					 Executive Law, I direct the implementation of the State Comprehensive Emergency
					 Management Plan and authorize necessary State agencies to take appropriate
					 action to assist local governments and individuals in the protection of public
					 health, welfare, and safety.
IN ADDITION, by virtue of the authority vested in me by
					 Section 29-a of Article 2-B of the Executive Law to temporarily suspend or
					 modify any statute, local law, ordinance, order, rule, or regulation, or parts
					 thereof, of any agency during a State disaster emergency, if compliance with
					 such statute, local law, ordinance, order, rule, or regulation would prevent,
					 hinder, or delay action necessary to cope with the disaster emergency, I hereby
					 temporarily suspend or modify, for the period from the date of this Executive
					 Order through October 27, 2021 the following:
* Sections 6512 through 6516, and 6524  of the Education Law
					 and Part 60 of Title 8 of the NYCCR to the extent necessary to allow physicians
					 licensed and in current good standing in any state in the United States to
					 practice medicine in New York State without civil or criminal penalty related
					 to lack of licensure, and to allow physicians licensed and in current good
					 standing in any province or territory of Canada, or any other country as
					 approved by the Department of Health to practice medicine in New York State
					 without civil or criminal penalty related to lack of licensure;
* Section 6502  of the Education Law and Section 59.8 of
					 Title 8 of the NYCRR, to the extent necessary to allow physicians licensed and
					 in current good standing in New York State but not registered in New York State
					 to practice in New York State without civil or criminal penalty related to lack
					 of registration;
* Sections 6512 through 6516, and 6905, 6906 and 6910  of
					 the Education Law and Part 64 of Title 8 of the NYCRR, to the extent necessary
					 to allow registered nurses, licensed practical nurses, and nurse practitioners
					 licensed and in current good standing in any state in the United States to
					 practice in New York State without civil or criminal penalty related to lack of
					 licensure, and to allow registered nurses, licensed practical nurses, and nurse
					 practitioners or a substantially similar title licensed and in current good
					 standing in any province or territory of Canada, or any other country as
					 approved by the Department of Health, to practice in New York State without
					 civil or criminal penalty related to lack of licensure;
* Sections 6512 through 6516, and 6541  of the Education Law
					 and Part 60,8 of Title 8 of the NYCRR, to the extent necessary to allow
					 physician assistants licensed and in current good standing in any state in the
					 United States to practice in New York State without civil or criminal, penalty
					 related to lack of licensure, and to allow physician assistants or a
					 substantially similar title licensed and in current good standing in any
					 province or territory of Canada, or any other country as approved by the
					 Department of Health to practice in New York State without civil or criminal
					 penalty related to lack of licensure;
* Sections 3502 and 3505  of the Public Health Law and Part
					 89 of Title 10 of the NYCRR to the extent necessary to permit radiologic
					 technologists licensed and in current good standing in any state in the United
					 State to practice in New York State without civil or criminal penalty related
					 to lack of licensure;
* Sections 8502, 8504, 8504-a, 8505, and 8507  of the
					 Education Law and Subpart 79-4 of Title 8 of the NYCRR, to the extent necessary
					 to allow respiratory therapists licensed and in current good standing in any
					 state in the United States to practice in New York State without civil or
					 criminal penalty related to lack of licensure;
* Sections 6512 through 6516 and 8510  of the Education Law
					 and 8 NYCRR Subpart 79-4 to the extent necessary to allow respiratory therapy
					 technicians licensed and in current good standing in any state in the United
					 States to practice in New York State without civil or criminal penalty related
					 to lack of licensure;
* Section 6502  of the Education Law and 8 NYCRR 59.8, to
					 the extent necessary to allow physician's assistants, registered professional
					 nurses, licensed practical nurses, and nurse practitioners licensed and in
					 current good standing in New York State but not registered in New York State to
					 practice in New York State without civil or criminal penalty related to lack of
					 registration, and to allow specialist assistants, respiratory therapists,
					 respiratory therapist technicians, pharmacists, clinical nurse specialists,
					 dentists, dental hygienists, registered dental assistants, midwives,
					 perfusionists, clinical laboratory technologists, cytotechnologists, certified
					 clinical laboratory technicians, certified histological technicians, licensed
					 clinical social workers, licensed master social workers, podiatrists, physical
					 therapists, physical therapist assistants, mental health counselors,
					 marriage-arid family therapists, creative arts therapists, psychoanalysts and
					 psychologists who have an unencumbered license and are currently in good
					 standing in New York State but not registered in New York State to practice in
					 New York State without civil or criminal penalty related to lack of
					 registration;
* Sections 6951, 6952, 6953 and 6955  of the Education Law,
					 to the extent necessary to allow midwives licensed and in current good standing
					 in any state in the United States, or in any province or territory of Canada,
					 or any other country as approved by the Department of Health to practice in New
					 York State without civil or criminal penalty related to lack of
					 licensure;
* Section 3507  of the Public Health Law and Part 89 of
					 Title 10 of the NYCRR to the extent necessary to permit radiologic
					 technologists licensed and in current good standing in New York State but not
					 registered in New York State to practice in New York State without civil or
					 criminal penalty related to lack of registration;
* Sections 6512 through 6516, 6548 and 6911  of the
					 Education Law and sections 60.11 and 64,8 Title 8 of the NYCRR, to the extent
					 necessary to allow clinical nurse specialists, specialist assistants, and
					 substantially similar titles certified and in current good -standing in any
					 state in the United States, or any province or territory of Canada, or any
					 other country as approved by the Department of Health to practice in New York
					 State without civil or criminal penalty related to lack of
					 certification;
* Sections 6512 through 6516, and 7704  of the Education Law
					 and Part 74 of Title 8 of the NYCRR, to the extent necessary to allow licensed
					 master social workers, licensed clinical social workers, and substantially
					 similar titles licensed and in current good standing in any state in the United
					 States, or in any province or. territory of Canada, or any other country as
					 approved by the Department of Health to practice in New York State without
					 civil or criminal penalty related to lack of licensure;
* Section 6908  of the Education Law and associated
					 regulations, to the extent necessary to permit graduates of State Education
					 Department registered, licensure qualifying nurse practitioner education
					 programs to be employed to practice nursing in a hospital or nursing home for
					 180 days immediately following successful completion of a New York State
					 Registered licensure qualifying education program, provided that the graduate
					 files with the State Education Department an application for certification as a
					 nurse practitioner;
* Section 8609  of the Education Law and associated
					 regulations, to the extent necessary to permit graduates of State Education
					 Department registered, licensure qualifying clinical laboratory technology and
					 clinical laboratory technician education programs to be employed to practice
					 for 180 days immediately following successful completion of a New York State
					 Registered licensure qualifying education program, in a clinical laboratory
					 with a valid New York State permit, provided that the graduate files an
					 application for a New York State clinical laboratory practitioner license and
					 limited permit;
* Subdivision 5 of Section 6907  of the Education Law and
					 associated regulation, to the extent necessary to permit graduates of
					 registered professional nurse and licensed practical nurse licensure qualifying
					 education programs registered by the State Education Department to be employed
					 to practice nursing under the supervision of a registered professional nurse
					 and with the endorsement of the employing hospital or nursing home for 180 days
					 immediately following graduation;
* Section 6524  of the Education Law, section 60.7 of title
					 8 of NYRR and section paragraph (1) of subdivision (g) 405.4 of title 10 of
					 tire NYCRR to the extent necessary to allow any physician who will graduate in
					 2021 or 2022 from an academic medical program accredited by a medical education
					 accrediting agency for medical education by the Liaison Committee on Medical
					 Education or the American Osteopathic Association, and has been accepted by an
					 Accreditation Council for Graduate Medical Education accredited residency
					 program within or outside of New York State to practice at any institution
					 under the supervision of a licensed physician;
* Sections 6512 through 6516, and 6524  of the Education Law
					 and Part 60 of Title 8 of the NYCRR, to the extent necessary to allow
					 individuals, who graduated from registered or accredited medical programs
					 located in New York State in 2021, to practice medicine in New York State,
					 without the need to obtain a license and without civil or criminal penalty
					 related to lack of licensure, provided that the practice of medicine by such
					 graduates shall in all cases be supervised by a physician licensed and
					 registered to practice medicine in the State of New York;
* Section 212  of the Retirement and Social Security Law,
					 for the purpose of disregarding any income earned during the period of the
					 emergency from the earnings limitation calculated under such section;
* Section 2805-k  of the Public Health Law and sections
					 405.4,
					 405.5,
					 405.9,
					 405.14,
					 405.19, and 405.22 of Title 10 of
					 the NYCRR, to the extent necessary to allow staff with the necessary
					 professional competency and who are privileged and credentialed to work in a
					 facility in compliance with such section of the Public Health Law and such
					 sections of the NYCRR, or who are privileged and credentialed to work in a
					 facility in another state in compliance with the applicable laws and
					 regulations of that other state, to practice in a facility in New York
					 State;
* Article 30 of the Public Health Law to the extent
					 necessary to allow EMTs and Advanced EMTs to provide emergent and non-emergent
					 services within their scope of practice beyond settings currently authorized,
					 such as hospitals;
* Subdivision d and u of section
					 800.3 of Title 10 of the NYCRR, to
					 the extent necessary to permit emergency medical service personnel to provide
					 community paramedicine, use alternative destinations, telemedicine to
					 facilitate treatment of patients in place, and such other services as may be
					 approved by the Commissioner of Health;
* Subdivision (7) of Public Health Law section 3001, and
					 subdivision (p) of section
					 800.3 of Title 10 of the NYCRR, to
					 the extent necessary to allow certified emergency medical
					 technician-paramedics, providing community paramedicine services with prior
					 approval of the Department of Health, to administer vaccinations against
					 influenza and COVID-19 pursuant to a non-patient specific order and under the
					 medical direction of a licensed physician, provided, however, that emergency
					 medical technician-paramedics must first meet conditions set by the
					 Commissioner of Health;
* Section 6951  of the Education Law, and section
					 79-5.5 of Title 8 of NYCRR, insofar
					 as such provisions limit the practice of midwifery to management of normal
					 pregnancies, child birth and postpartum care as well as primary preventive
					 reproductive health care of essentially healthy women, and newborn evaluation,
					 resuscitation and referral for infants, and insofar as it limits the practice
					 of midwifery to midwives who practice in accordance with collaborative
					 relationships with licensed physicians or hospitals, so that for the purposes
					 of this disaster emergency, midwives may administer vaccinations against
					 influenza and COVID-19 to any patient pursuant to a non-patient specific order
					 at sites overseen or approved by the New York State Department of Health or
					 local health departments, and operated under the medical supervision of
					 licensed physicians, licensed physician assistants, or certified nurse
					 practitioners, provided, however, that a midwife without a certificate issued
					 by the State Education Department for administering immunizing agents, must
					 meet conditions set by the Commissioner of Health;
* Article 139 of the Education Law, Section 576-b  of the
					 Public Health Law and Section
					 58-1.7 of Title 10 of the NYCRR,
					 to the extent necessary to permit registered nurses to order the collection of
					 throat or nasopharyngeal swab specimens from individuals suspected of being
					 infected by COVID-19, for purposes of testing;
* Subdivision 1 of section 6902, Subdivision 4, 5 and 7 of
					 section 6909  of the Education Law, subdivision 6 and 7 of section 6527  of the
					 Education Law, and section 63.9 and 64.7 of Title 8 of the NYCRR, to the extent
					 necessary to permit physicians and certified nurse practitioners to issue a
					 non-patient specific regimen to nurses or any such other persons authorized by
					 law or by this executive order to
(1) 
					 collect throat or nasopharyngeal swab specimens from individuals suspected of
					 suffering from a COVID-19 infection, for purposes of testing, or to perform
					 such other tasks as may be necessary to provide care for individuals diagnosed
					 or suspected of suffering from a COVID-19 infection;
(2) collect blood specimens for the diagnosis
					 of acute or past COVID-19 disease;
(3) administer vaccinations against influenza
					 or COVID-19 pursuant to the most recent recommendations by the Advisory
					 Committee for Immunization Practices (ACEP) and/or an applicable United States
					 Food and Drug Administration approval or Emergency Use Authorization (EUA),
					 subject to any other conditions set forth in this Order, including but not
					 limited to conditions related to training and supervision, where applicable;
					 and
(4) where applicable and to the
					 extent necessary, to perform tasks, under the supervision of a nurse, otherwise
					 limited to the scope of practice of a licensed or registered nurse to provide
					 care for individuals ;
* Sections 6521 and 6902  of the Education Law, subdivisions
					 4, 5, and 7 of section 6909  of the Education Law, subdivisions 6 and 7 of
					 section 6527  of the Education Law, and sections 63.9 and 64.7 of Title 8 of the
					 NYCRR insofar as they limit the execution of medical regimens prescribed by a
					 licensed physicians or other licensed and legally authorized health care
					 providers to registered nurses licensed pursuant to Article 139 of the
					 Education Law, to the extent necessary to permit non-nursing staff, as
					 permitted by law and upon completion of training deemed adequate by the
					 Commissioner of Health, to:
(1) collect
					 throat, nasal, or nasopharyngeal swab specimens, as applicable and appropriate,
					 from individuals suspected of being infected by COVID-19 or influenza, for
					 purposes of testing;
(2) collect
					 blood specimens for the diagnosis of acute or past COVID-19 disease;
(3) administer vaccinations against influenza
					 or COVID-19 pursuant to the most recent recommendations by the Advisory
					 Committee for Immunization Practices (ACIP) and/or an applicable United States
					 Food and Drug Administration approval or Emergency Use Authorization (EUA),
					 subject to any other conditions set forth in this Order, including but not
					 limited to conditions related to training and supervision, where applicable;
					 and
(4) where applicable and to the
					 extent necessary, to perform tasks, under the supervision of a nurse, otherwise
					 limited to the scope of practice of a licensed or registered nurse to provide
					 care for individuals;
* Subdivision (b) of section 405.3 of Title 10 of the
					 NYCRR, to the extent necessary to allow general hospitals to use qualified
					 volunteers or personnel affiliated with different general hospitals, subject to
					 the terms and . conditions established by the Commissioner of Health;
* Section 400.9 and paragraph 7 of subdivision h of section
					 405.9 of Title 10 of the NYCRR, to
					 the extent necessary to permit general hospitals and nursing homes licensed
					 pursuant to Article 28 of the Public Health Law that are treating patients
					 during the disaster emergency to discharge, transfer, or receive such patients,
					 as authorized by the Commissioner of Health if necessary due to staffing
					 shortages, provided such facilities take all reasonable measures to protect the
					 health and safety of such patients and residents, including safe transfer and
					 discharge practices, and to comply with the Emergency Medical Treatment and
					 Active Labor Act (42
					 U.S.C. section 1395dd) and any associated
					 regulations;
* Section 64.7 of Title 8 of the NYCRR to expand
					 nurse-initiated protocols to include electrocardiogram (EKG) for signs and
					 symptoms of acute coronary syndrome, blood glucose for altered mental state,
					 Labs and intravenous lines for potential sepsis and pre-procedure pregnancy
					 testing to expedite evaluation and diagnosis;
* Section
					 415.15 of Title 10 of the NYCRR to
					 the extent necessary to allow physician visits for nursing home residents to be
					 performed via telemedicine;
* Sections
					 405.13 and
					 755.4 of Title 10 of the NYCRR to
					 the extent necessary to permit an advanced practice registered nurse with a
					 doctorate or master's degree specializing in the administration of anesthesia
					 administering anesthesia in a general hospital or free-standing ambulatory
					 surgery center without the supervision of a qualified physician in these health
					 care settings;
* Sections
					 800.3,
					 800.8,
					 800.9,
					 800.10,
					 800.12,
					 800.17,
					 800.18,
					 800.23,
					 800.24, and 800.26 of Title 10 of
					 the NYCRR to the extent necessary to extend all existing emergency medical
					 services provider certifications for one year; to permit the Commissioner of
					 Health to modify fire examination or recertification requirements for emergency
					 medical services provider certifications; to suspend or modify, at the
					 discretion of the Commissioner of Health, any requirements for the
					 recertification of previously certified emergency medical services providers;
					 and, at the discretion of the Commissioner of Health, develop a process
					 determined by the Department of Health, to permit any emergency medical
					 services provider certified or licensed by another State to provide emergency
					 medical services within New York state; at the discretion of the Commissioner
					 of Health, to suspend or modify equipment or vehicle requirements in order to
					 ensure sustainability of EMS operations;
* Subdivision (15) of section 3001, and sections 80
					 0.3,800.15 and 80 0.16 of Title 10 of the NYCRR with approval of the Department
					 of Health, to the extent necessary to define "medical control" to also include
					 emergency and non-emergency direction to emergency medical services personnel
					 by a regional or state medical control center and to permit emergency medical
					 services personnel to operate under the advice and direction of a nurse
					 practitioner, physician assistant, or paramedic, provided that such medical
					 professional is providing care under the supervision of a physician and
					 pursuant to a plan approved by the Department of Health;
* Section 3001, 3005-a, 3008, and 3 010 of the Public
					 Health Law to the extent necessary to modify the definition of "emergency
					 medical services" to include emergency, non-emergency and low acuity medical
					 assistance only for the purpose of eliminating restrictions on an approved
					 ambulance services or providers operating outside of the primary territory
					 listed on such ambulance service's operating certificate with prior approval by
					 the Department of Health; to permit the Commissioner of Health to issue
					 provisional emergency medical services provider certifications to qualified
					 individuals with modified certification periods as approved; and to allow
					 emergency medical services to transport patients to locations other than
					 healthcare facilities with prior approval by Department of Health;
* Sections 6502, 6524, 6905, 6906 and 6910  of the education
					 law and Part 59.8 of Title 8 of the NYCRR to the extent necessary to authorize
					 retired physicians, registered professional nurses, licensed practical nurses,
					 and nurse practitioners licensed to practice and in current good standing in
					 New York State, but not currently registered in New York State, to re-register
					 through use of an expedited automatic registration form developed by the state
					 and to waive any registration fee for the triennial registration period for
					 such registrants;
* Paragraph 1 of section 6542  of the Education Law,
					 Paragraph 1 of section 6549  of the Education Law, and Subdivisions (a) and (b)
					 of Section 94.2 of Title 10 of the NYCRR to the extent necessary to permit a
					 physician assistant, and to permit a specialist assistant, to provide medical
					 services appropriate to their education, training and experience without
					 oversight from a supervising physician without civil or criminal penalty
					 related to a lack of oversight by a supervising physician;
* Subdivision (3) of section 6902  of Education Law, and any
					 associated, regulations, including, but not limited to, Section 64.5 of Title
					 10 of the NYCRR, to the extent necessary to permit a nurse practitioner to
					 provide medical services appropriate to their education, training and
					 experience, without a written practice agreement, or collaborative relationship
					 with a physician, without civil or criminal penalty related to a lack of
					 written practice agreement, or collaborative relationship, with a
					 physician;
* Subparagraph (ii) of paragraph (2) of subdivision (g) of
					 10 N.Y.C.R.R. section 405.4, to the extent necessary to allow graduates of
					 foreign medical schools having at least one year of graduate medical education
					 to provide patient care in hospitals, is modified so as to allow such graduates
					 without licenses to provide patient care in hospitals if they have completed at
					 least one year of graduate medical education;
* Subdivision 4 of section 6909  of the Education Law,
					 subdivision 6 of section 6527  of the Education Law, and section 64,7 of Title 8
					 of the NYCRR, to the extent necessary to permit physicians and certified nurse
					 practitioners to issue a non-patient specific regimen to nurses or any such
					 other persons authorized by law or by this executive order to collect throat or
					 nasopharyngeal swab specimens from individuals suspected of suffering from a
					 COVID-19 infection, for purposes of testing, or to perform such other tasks as
					 maybe necessary to provide care for individuals diagnosed or suspected of
					 suffering from a COVID-19 infection;
* Sections 8602 and 8603  of the Education Law, and section
					 58-1.5 of Title 10 of the NYCRR, to the extent necessary to permit individuals
					 who meet the federal requirements for high complexity testing to perform
					 testing for the detection of SARS-CoV-2 in specimens collected from individuals
					 suspected of suffering from a COVID-19 infection;
* Article 165 of the Education Law and section 58-1.3 of
					 Title 10 of the NYCRR, to the extent necessary to allow clinical laboratory
					 practitioners to perform testing in a clinical laboratory under remote
					 supervision, provided a supervisor is on-site at least eight hours per
					 week;
* Subdivision 32 of Section 6530  of the Education Law,
					 Paragraph (3) of Subdivision (a) of Section 29.2 of Title 8 of the NYCRR, and.
					 Sections 58-1.11,
					 405.10, and
					 415.22 of Title 10 of the NYCRR,
					 only to the extent necessary for health care providers to be relieved of
					 recordkeeping requirements, including but not limited to assigning diagnostic
					 codes or creating or maintaining other records for billing purposes, without
					 civil or criminal penalty imposed by the Department of Health or State
					 Education Department;
* Section 112  of the State Finance Law, to the extent
					 consistent with Article V, Section
					 1 of the State Constitution, and to
					 the extent necessary to add additional work, sites, and time to State contracts
					 or to award emergency contracts, including but not limited to emergency
					 contracts or leases for relocation and support of State operations under
					 section 3  of the Public Buildings Law; or emergency contracts under Section 9 
					 of the Public Buildings Law; or emergency contracts for professional services
					 under Section 136 - a of the State Finance Law; or emergency contracts for
					 commodities, services, and technology under Section 163  of the State Finance
					 Law; or emergency contracts for purchases of commodities, services, and
					 technology through any federal GSA schedules, federal 1122 programs, or other
					 state, regional, local, multi-jurisdictional, or cooperative contract
					 vehicles;
* Section 163  of the State Finance Law and Article 4-C of
					 the Economic Development Law, to the extent necessary to expedite contracting
					 for necessary services, commodities, and technology;
* Section 4903  of the Insurance Law and Section 4903  of the
					 Public Health Law only to the extent necessary to increase availability of
					 healthcare staff, upon certification by the hospital to the health plan, by
					 suspending requirements for preauthorization review for scheduled surgeries in
					 hospital facilities, hospital admissions, hospital outpatient services, home
					 health care services following a hospital admission, and inpatient and
					 outpatient rehabilitation services following a hospital admission; and to
					 suspend concurrent review for inpatient and outpatient hospital services; and
					 to suspend retrospective review for inpatient and outpatient hospital services
					 at in-network hospitals; during the pendency of this Executive Order only;
					 and
* Subsection c of section 4904  of the Insurance Law,
					 paragraph 1 of subsection b of section 4914  of the Insurance Law, subdivision 3
					 of section 4904  of the Public Health Law, and paragraph a of subdivision 2 of
					 section 4914  of the Public Health Law, to toll statutory timeframes required
					 for hospital submission of an internal appeal and external appeal only to the
					 extent necessary to increase availability of healthcare staff during the
					 pendency of this Executive Order only.
GIVEN under my hand and the Privy Seal of the State in the
					 City of Albany this twenty-seventh day of September in the year two thousand
					 twenty-one.
Signed: Kathy Hochul
Dated: September 27, 2021