Government : Governor Reynolds New Extension: Part 1 Health

Today, Gov. Reynolds signed a new proclamation continuing the State Public Health Emergency Declaration, suspending elective and nonessential medical and dental procedures, extending and expanding retail business closures, ordering health care facilities and nursing homes to engage in advanced health care screenings, and removing additional legal barriers to ensure a continued strong response to this disaster. 

The state of public health disaster emergency shall expire on April 16, 2020, at 11:59 p.m., unless sooner terminated or extended by the governor.

Read the full text of the proclamation below or online here: 

WHEREAS, the World Health Organization has reported an outbreak of thousands of cases of Novel Coronavirus 2019 (COVID-19) in multiple countries, causing illness and deaths; and

WHEREAS, on January 31, 2020, the United States Department of Health and Human Services declared a national public health emergency; and

WHEREAS, on March 9, 2020, a Proclamation of Disaster Emergency was issued to coordinate the State of Iowa's response to this outbreak and such disaster continues to exist; and

WHEREAS, on March 11, 2020 the World Health Organization declared the COVID-19 outbreak a global pandemic; and

WHEREAS, on March 13, 2020, President Donald J. Trump issued a proclamation declaring that the COVID-19 outbreak in the United States constitutes a national emergency; and

WHEREAS, on March 17, 2020, a Proclamation of Public Health Disaster Emergency was issued to provide additional needed resources and measures to respond to this disaster, and such public health disaster continues to exist; and

WHEREAS, responding to this public health disaster requires the preservation of personal protective equipment to protect our healthcare workforce and the preservation of critical hospital capacity for Iowans impacted by the COVID-19 outbreak or needing other essential medical care; and

WHEREAS, the risk of transmission of COVID-19 may be substantially reduced by continuing to temporarily close certain public establishments and closing additional nonessential retail establishments; and

WHEREAS, strict compliance with the regulatory provisions of Iowa Code § 514C.34 excluding the definition of telehealth the provision of services through audio-only telephone transmission would prevent, hinder, or delay necessary action in coping with this disaster in all counties of our state and ensuring equity in the payment to providers of telehealth services will prevent the transmission of COVID-19; and help ensure that all cases of COVID-19 are properly identified, controlled, and treated; and promote the uniformity, cost efficiency, and transparency of health benefit plans in Iowa; and

WHEREAS, mandatory screening of staff of hospitals, nursing facilities, intermediate care facilities, residential care facilities, and assisted living programs would help prevent the transmission of COVID-19 and help ensure that all cases of the disease are properly identified, controlled, and treated; and

WHEREAS, strict compliance with the provisions of Iowa law imposing limitations on the number of clinical hours that may be satisfied through simulation for nursing education programs would prevent, hinder, or delay necessary action in coping with this disaster in all counties of our state; and

WHEREAS, strict compliance with Iowa Admin. Code rules 650-11.2(2), 11.3(2), 11.5(2), 11.6(2),13.2(2), and 20.6(2)(b)(8) requiring an applicant for initial licensure in dentistry, dental hygiene, assisting, or for a faculty permit to attest to current certification in cardiopulmonary resuscitation would prevent, hinder, or delay necessary action in coping with this disaster in all counties of our state; and

WHEREAS, strict compliance with the provisions of Iowa Code § 135C.33 and Iowa Admin Code rules 481-50.9(3) & (9) and 67.19(3), requiring a health care facility and assisted living program to complete a criminal history check prior to employment of an individual in a health care facility or assisted living program, would prevent, hinder, or delay necessary action in coping with this disaster in all counties of our state; and

WHEREAS, strict compliance with the provisions of Iowa Code § 135C.8 and Iowa Admin Code rules 481-58.3(3)(a), requiring a nursing facility to submit renewal applications at least 30 days in advance of license expiration, would prevent, hinder, or delay necessary action in coping with this disaster in all counties of our state; and

WHEREAS, strict compliance with the provisions of Iowa Admin Code rules 481-58.21(6)(d) & 65.17(1)(d), requiring nursing students to administer medications in nursing facilities and immediate care facilities for persons with mental illness only after successful completion of a medication aide course or challenge exam, would prevent, hinder, or delay necessary action in coping with this disaster in all counties of our state; and

WHEREAS, strict compliance with the provisions of Iowa Admin Code rules 481-57.20(1) & 58.23(1)(a), requiring residential care facilities and nursing facilities assist residents to obtain regular and emergency dental services, would prevent, hinder, or delay necessary action in coping with this disaster in all counties of our state; and

WHEREAS, strict compliance with the provisions of Iowa Admin Code rules 481-57.23(1) & 58.26(1) requiring group activities provided by residential care facilities and nursing facilities, would prevent, hinder, or delay necessary action in coping with this disaster in all counties of our state; and

WHEREAS, strict compliance with the provisions of Iowa Admin. Code rule 481-58.47, permitting in-person visits with residents in nursing facilities, would prevent, hinder, or delay necessary action in coping with this disaster in all counties of our state; and

WHEREAS, strict compliance with the provisions of Iowa Code § 231C.3(1)(c) and Iowa Admin Code rules 481-69.22(2) & 481-57.22(3) requiring an assisted living program and residential care facility to update a tenant's or resident's service plan within thirty days of occupancy or admission would prevent, hinder, or delay necessary action in coping with this disaster in all counties of our state; and

WHEREAS, strict compliance with the provisions of Iowa Code § 231C.8(1) and Iowa Admin. Code rule 481-67.13(1) requiring an assisted living program to submit any additional or rebuttal information to the department within two working days of an exit interview at the conclusion of a monitoring evaluation or complaint investigation would prevent, hinder, or delay necessary action in coping with this disaster in all counties of our state; and

WHEREAS, strict compliance with the provisions of Iowa Admin. Code rule 481-67.5(2) requiring a person administering medications in an assisted living program have, at a minimum, passed a medication manager course and examination would prevent, hinder, or delay necessary action in coping with this disaster in all counties of our state; and

WHEREAS, strict compliance with the provisions of Iowa Admin. Code rule 481-69.29(5) & (6) requiring a new program manager and delegating nurse in assisted living programs complete an assisted living management class and/or an assisted living nursing class within six months of employment would prevent, hinder, or delay necessary action in coping with this disaster in all counties of our state; and

WHEREAS, strict compliance with the provisions of Iowa Admin. Code rule 481-57.11(6) requiring a residential care facility employee have a physical examination no longer than twelve months prior to beginning employment would prevent, hinder, or delay necessary action in coping with this disaster in all counties of our state; and

WHEREAS, strict compliance with the provisions of Iowa Admin. Code rule 481-57.11(6) requiring a residential care facility screen and test an employee for tuberculosis pursuant to 481-Chapter 59 would prevent, hinder, or delay necessary action in coping with this disaster in all counties of our state; and

WHEREAS, strict compliance with the provisions of Iowa Admin. Code rules 481-57.19(3)(c) & 64.4(9)(b) requiring a person administering medications in a residential care facility and intermediate care facility for the intellectually disabled to complete a department-approved medication aide course and pass a department-approved medication aide exam would prevent, hinder, or delay necessary action in coping with this disaster in all counties of our state; and

WHEREAS, strict compliance with the provisions of Iowa Admin. Code rule 481-57.22(1) requiring a residential care facility provide orientation within twenty-four hours of admission would prevent, hinder, or delay necessary action in coping with this disaster in all counties of our state; and

WHEREAS, strict compliance with the provisions of Iowa Code § 135C.36 and Iowa Admin. Code rules 481-56.2 & 67.17, requiring fines for a health care facility or assisted living program, would prevent, hinder, or delay necessary action in coping with this disaster in all counties of our state; and

WHEREAS, strict compliance with the provisions of Iowa Admin Code rules 481-57.14(1)(e) and 58.40(1)(c) permitting a residential care facility or nursing facility to involuntarily discharge or transfer a resident for nonpayment for the resident's stay would prevent, hinder, or delay necessary action in coping with this disaster in all counties of our state; and

WHEREAS, to assist hospitals and public safety departments in maintaining staffing to best respond to medical and public safety needs during the COVID-19 disaster emergency, strict compliance with the regulatory provisions of Iowa Code §§ 97B.48A and 97B.52A reducing a member's retirement allowance if the member is reemployed or returns to employment during the pendency of this Disaster would prevent, hinder, or delay necessary action in coping with this disaster in all counties of our state; and suspending these provisions will help ensure that all cases of COVID-19 are properly identified, controlled, and treated; and

WHEREAS, strict compliance with the regulatory provisions of Iowa Code §§ 411.3(3), 411.6(1)(c), and 411.21(3) limiting a retired police officer or firefighter continuing to receive service retirement allowances, without interruption, if reemployed during the pendency of this Disaster Emergency would prevent, hinder, or delay necessary action in coping with this disaster in all counties of our state; and suspending these provisions will help ensure that all cases of COVID-19 are properly identified, controlled, and treated; and

WHEREAS, strict compliance with the provisions of Iowa Code § 15B.4, limiting the use of online instruction in determining contact hours for apprenticeship sponsors or lead apprenticeship sponsors would prevent, hinder, or delay necessary action in coping with this disaster in all counties of our state; and

WHEREAS, strict compliance with the provisions of Iowa Code § 321.20A prescribing the owner of a commercial vehicle subject to the apportioned registration provisions of chapter 326 apply for a certificate of title within thirty days of purchase or transfer and pay the appropriate fee for new registration would prevent, hinder, or delay necessary action in coping with this disaster in all counties of our state; and

WHEREAS, strict compliance with the provisions of Iowa Code § 321.52(4)(b) requiring a salvage certificate of title for a wrecked or salvage vehicle to be obtained within thirty days after the date of assignment of the certificate of title of the vehicle would prevent, hinder, or delay necessary action in coping with this disaster in all counties of our state; and

WHEREAS, strict compliance with the registration deadline and late filing penalty for renewals under Iowa Code § 326.14 for commercial motor carriers subject to the International Registration Plan would prevent, hinder, or delay necessary action in coping with this disaster in all counties of our state; and

WHEREAS, strict compliance with the provisions of Iowa Code § 602.8107 deeming court debt delinquent if not paid within thirty days after the date the debt was assessed, the date set out in a court order, or the date due in an installment agreement, and the case assigned by the Iowa Judicial Branch to a third party for collection would prevent, hinder, or delay necessary action in coping with this disaster in all counties of our state; and

WHEREAS, strict compliance with the regulatory provisions of Iowa Code §§ 648.3 and 648.5 requiring service of a notice to quit or service of original notice before commencing an action under Iowa Code § 648.1(2)-(6) would prevent, hinder, or delay necessary action in coping with this disaster in all counties of our state.

NOW THEREFORE, I, KIMBERLY K. REYNOLDS, Governor of the State of Iowa, by the power and authority vested in me by the Iowa Constitution, Art. IV, §§ 1, 8 and Iowa Code §§ 29C.6(1), 135.140(6), and 135.144 do hereby proclaim a STATE OF PUBLIC HEALTH DISASTER EMERGENCY continues to exist throughout the entire state of Iowa and do hereby ORDER and DIRECT the following:

NONESSENTIAL MEDICAL AND DENTAL SERVICES

SECTION ONE.  Pursuant to Iowa Code § 135.144(3), and in conjunction with the Iowa Department of Public Health, unless otherwise modified by subsequent proclamation or order of the Iowa Department of Public Health, I hereby order that effective at 5:00 p.m. on March 27, 2020, and continuing until this disaster proclamation expires:

A.   All nonessential or elective surgeries and procedures that utilize personal protective equipment (PPE) must not be conducted by any hospital, outpatient surgery provider, or outpatient procedure provider, whether public, private, or nonprofit.

B. A nonessential surgery or procedure is one that can be delayed without undue risk to the current or future health of a patient, considering all appropriate factors including, but not limited to any: (1) threat to the patient's life if the surgery or procedure is not performed; (2) threat of permanent dysfunction of an extremity or organ system; (3) risk of metastasis or progression of staging; and (4) risk of rapidly worsening to severe symptoms.

C. Each hospital, outpatient surgery provider, and outpatient procedure provider shall limit all nonessential individuals in surgery and procedure suites and patient care areas where PPE is required. Only individuals essential to conducting the surgery or procedure shall be present in such areas.

D.   Each hospital, outpatient surgery provider, and outpatient procedure provider shall establish an internal governance structure to ensure that the principles outlined above are followed.

SECTION TWO.  Pursuant to Iowa Code § 135.144(3), and in conjunction with the Iowa Department of Public Health, unless otherwise modified by subsequent proclamation or order of the Iowa Department of Public Health, I hereby order that effective at 5:00 p.m. on March 27, 2020, and continuing until this disaster proclamation expires:

A.   All dentists and their staff shall not perform elective dental procedures, including: any cosmetic or aesthetic procedures; all routine hygiene; any orthodontic procedures other than those necessary to relieve pain or infection or to restore normal oral functioning; initiation of crowns, bridges, or dentures that do not address or prevent pain or restore normal oral functioning; any periodontal plastic surgery; extraction of asymptomatic non-carious teeth; recall visits for periodontally-healthy patients; and all appointments for high-risk patients, including ASA 2 and 3 patients, unless emergent. 

B. This order does not prohibit the provision of emergency dental services. 

C. This order shall be enforced by Iowa Dental Board investigators or their designees who, pursuant to Iowa Code § 153.33(1)(b), shall have the powers and status of peace officers when enforcing this order.

D.   The Iowa Dental Board shall provide additional guidance to its licensees pursuant to Iowa Code § 29C.19 regarding the nature and scope of this restriction, to the extent necessary to protect the public health and ensure continuity of services to Iowans.

TELEHEALTH SERVICES

SECTION THREE.  Pursuant to Iowa Code § 29C.6(6) and Iowa Code § 135.144(3), and in conjunction with the Iowa Department of Public Health, I temporarily suspend the regulatory provision of Iowa Code chapters § 514C.34 to the extent that it excludes the definition of telehealth the provision of services through audio-only telephone transmission, and I direct the Insurance Commissioner to use all available means, including the authority of Iowa Code §§ 505.8(1), (7), and 29C.19, to ensure that any health carrier, as defined in Iowa Code § 514J.102, shall reimburse a health care professional, as defined in Iowa Code § 514J.102, for medically necessary, clinically appropriate covered services by telehealth, as defined in § 514C.34(1) or via audio-only telephone transmission, provided to a covered person, as defined in Iowa Code § 514J.102, on the same basis and at the same rate as the health carrier would apply to the same health care services provided to a covered person by the health care professional in person for the duration of this proclamation. I also encourage all Iowa businesses to take any necessary action to remove cost-sharing or other financial barriers to the use of telehealth in their health insurance plans.