American College Of Surgeons - Inspiring Quality: Highest Standards, Better Outcomes

State Resumption of Elective Surgery Orders, Guidance, and Resources

The ACS Local Resumption of Elective Surgery Guidance offers a set of principles and issues to help local facilities plan for resumption of elective surgical care.

State Orders

Alabama

Alabama State Amended Health Order, April 28, 2020, “Effective April 30, 2020, at 5:00 P.M., dental, medical, or surgical procedures may proceed unless the State Health Officer or his designee determines that performing such procedures, or any category of them (whether statewide or regionally), would unacceptably reduce access to personal protective equipment or other resources necessary to diagnose and treat COVID-19.” (sec 12, page 6)

New “Safer At Home Order” explainer

Alaska

Health Mandate 15, Updated April 21, 2020 Section II Provision for Resuming Non-Urgent/Non-Emergent Elective Surgeries and Procedures Section III goes into effect May 4, 2020

Arkansas

Article April 23, 2020 “Hospitals and clinics will be able to resume performing elective surgeries on Monday, April 27 that aren't expected to require overnight hospitalization. The surgeries will still be prohibited for a patient who has symptoms of COVID-19, the disease caused by the coronavirus, or has had contact within the past 14 days with someone who was infected with the virus. Providers will also have to test the patient for the virus within 48 hours before the surgery. "Initially, we're going to encourage the facilities to start with a smaller volume and to build up and to make sure they have adequate supplies of" personal protective equipment, said Department of Health Secretary Nate Smith. Rural hospitals with fewer than 60 beds were exempt from the ban on elective procedures and won't be subject to the new requirements.”

Surgery resumption April 27, 2020

Arkansas Department Health Directive issued 4/20/20

Arizona

Executive Order 2020-32

April 22 Presentation

Arizona Department of Health will establish minimum criteria for resuming elective surgery on May 1st.

Online Form: Healthcare Exemption Request from Executive Order 2020-10

Executive Order FAQ, April 27, 2020

Colorado

Press release April 22, 2020 “Elective medical and dental procedures begin, with strict precautions to ensure adequate personal protective equipment and the ability to meet critical care needs.”

Current elective surgery order set to expire April 26, 2020.

Governor’s presentation and one pager April 22, 2020

Colorado guidance listed in Executive Order D 2020 045 issued April 26, 2020

Press Release April 26, 2020 announcing new executive order

District of Columbia

Phase 1 Guidance Coronavirus 2019 (COVID-19) Guidance for Elective Surgery May 26, 2020

Florida

Executive Order 20-112, Easing Restrictions including Elective Surgery Effective May 4, 2020 (sec 5, page 5)

Illinois

Illinois Department of Health Guidance Elective Surgeries and Procedures

Elective Surgeries and Procedures FAQ's

Indiana

Executive Order 20-22 Extension (4/20/20)

Resumption of surgery on April 27: “In addition, as long as sufficient personal protective equipment (PPE), staff and other supplies are available so as not to detract from what is necessary and appropriate to properly care for and treat patients who have or may have COVID-19, hospitals should conduct clinically indicated procedures meant to diagnose, screen and treat medical conditions that have the potential for short-term or long-term morbidity and/or mortality. These include, but are not limited to, cardiac, vascular, neurologic, cancer, gastrointestinal and respiratory procedures, as well as those procedures meant to reduce significant pain or symptoms making quality of life unacceptable. Furthermore, in connection with health care providers, whether medical, dental or other, and health care facilities, whether hospitals, ambulatory surgical centers, dental facilities, plastic surgery centers, dermatology offices, abortion clinics, or veterinary practices, any current restrictions involving their medical procedures that have been imposed by an Executive Order will be re-evaluated for possible modifications, as warranted by the circumstances, that would allow for them to resume commencing as of 11:59 p.m. on Sunday, April 26, 2020. In addition, these restrictions on medical procedures will be re-evaluated every seven (7) days thereafter for any appropriate and timely modifications that could be implemented.

Guidance has not been posted

Iowa

Resumption of Surgery Guidance in New Public Health Emergency Declaration April 24, 2020

Kentucky

“Healthcare Phased Reopening” Presentation Dr. Steven Stack, commissioner for the Department for Public Health April 27, 2020

Louisiana

LDH Memo April 20, 2020: HEALTHCARE FACILITY NOTICE/ORDER NOTICE #2020-COVID19-ALL-010 AMENDED AND UPDATED NOTICE: Medical and Surgical Procedures Dental Visits, Procedures and Surgeries Other Healthcare Services

The Louisiana Department of Health Issues Revised Order for Medical and Surgical Procedures

Maryland

Amended Directive and Order Regarding Various Healthcare Matters May 5, 2020

Massachusetts

ORDER OF THE COMMISSIONER OF PUBLIC HEALTH REGARDING THE SCHEDULING AND PERFORMANCE OF URGENT ELECTIVE INVASIVE PROCEDURES May 18, 2020

Open DOC file, 54.5 KB, for DPH Elective Invasive Procedures Guidance Updated May 18, 2020

Website Reopening Health and Human Services in Massachusetts

Michigan

Press Release May 4, 2020, Guidelines on Non-essential Procedures Include Not Delaying Important Medical Care

Executive Order 2020-96 “Executive Order 2020-17, which imposed temporary requirements regarding the postponement of non-essential medical and dental procedures, is rescinded as of May 28, 2020 at 11:59 pm.”

Guidance has not been posted

Minnesota      

Executive Order 20-51 May 5, 2020 Requiring Facilities to Prioritize Surgeries and Procedures and Provide Safe Environment during COVID-19 Peacetime Emergency

MN Health Department Website: Surgeries and Procedures During COVID-19

Mississippi

Guidance incorporated into Executive Order No. 1477 (sec i, page 3)

Statement North Mississippi Medical Center in Tupelo to Resume Elective Surgeries on April 28

Nebraska

Press Release, April 20, 2020: Gov. Ricketts, Public Health Director Announce Guidelines to Resume Elective Surgeries in May

Nebraska Department of Health and Human Services Health Directive Update, April 29, 2020, Guidance for elective surgery included in individual county health directives

New Jersey

Executive Order 145, Resumption of surgery to begin May 26, 2020

Guidance for Ambulatory Surgery Centers, May 19, 2020

Guidance for Hospitals, May 19, 2020

New Mexico

Public Health Order New Mexico Department of Health, April 30, 2020, Public Health Emergency Order Modifying Temporary Restrictions on Non-Essential Health Care Services, Procedures, and Surgeries

Statement of Compliance with Public Health Order, May 1, 2020

Medically Necessary Surgery and Procedural Guidelines, April 28, 2020

New York

Press Release, April 21, 2020, Elective Outpatient Treatment Can Resume in Counties and Hospitals Without Significant Risk of COVID-19 Surge

Executive Order 202.25, April 29, 2020, Modifying Order on Elective Surgery

Guidance, April 29, 2020 State Department of Health

Guidance for ASC/OBS, May 19, 2020, State Department of Health

Press Conference, April 29, 2020, “35 counties have been approved to resume elective outpatient treatments. The Governor previously announced that the state will allow elective outpatient treatments to resume in counties and hospitals without significant risk of COVID-19 surge in the near term. The counties now eligible are: Allegany, Broome, Cattaraugus, Chautauqua, Chenango, Delaware, Dutchess, Essex, Franklin, Fulton, Genesee, Herkimer, Jefferson, Lewis, Livingston, Madison, Monroe, Niagara, Oneida, Onondaga, Ontario, Orleans, Oswego, Putnam, Saratoga, Schoharie, Schuyler, St. Lawrence, Steuben, Sullivan, Tompkins, Ulster, Wayne, Wyoming and Yates.”

Press Conference, May 13, 2020, Governor Cuomo Announces 12 More Counties Are Now Eligible to Resume Elective Surgeries

Ohio

Elective Surgery Order, April 22, 2020

Responsible RestartOhio - A Guide for Health Care

Responsible RestartOhio for Health Care Webinar

Oklahoma

Amended Exec Memo 2020-02, April 20, 2020 Elective Surgery Acuity Scale

Executive Order 3rd Amended 2020-13: “Oklahomans and medical providers in Oklahoma shall postpone all elective surgeries until April 24th, 2020. Elective surgeries on and after April 24th, 2020 are subject to the guidelines set forth in Amended Executive Memorandum 2020-02. Oklahomans and medical providers in Oklahoma shall postpone minor medical procedures and non-emergency dental procedures until April 30th, 2020. For purposes of aiding in the determination of what is considered an elective surgery, medical providers are encouraged to consult the Centers for Medicare & Medicaid Services (CMS) Non-Emergent, Elective Medical Services, and Treatment Recommendations.

Oregon

Press Release, April 23, 2020,Governor Kate Brown Issues Framework for Lifting Order on Non-Urgent Procedures, starting May 1

Oregon Health Authority Framework for Restarting Non-Emergent and Elective Procedures in Hospitals and Ambulatory Surgical Centers

Oregon Health Authority Framework for Restarting Non-Emergent and Elective Procedures in Medical and Dental Offices

Pennsylvania

Guidance on Hospitals’ Responses to COVID-10 April 27, 2020

Amended Order of the Secretary of the Pennsylvania Department of Health Requiring Ambulatory Surgical Facilities to Make Daily Reports of Specified Data Regarding Supplies and Equipment

Guidance on Ambulatory Surgical Facilities’ Responses to COVID-19 April 27, 2020

South Dakota

Executive Order 2020-20 and South Dakota’s Back to Normal Plan April 27, 2020

Tennessee

Article April 27, 2020 Hospitals can resume elective procedures May 1 in Tennessee

Tennessee Hospital Association PRINCIPLES FOR RETURNING TO ELECTIVE SURGERY AND PROCEDURES, April 27, 2020

Official state guidance has not been posted

Texas

TMB Adopts Emergency Rule to Enforce Gov. Abbott’s Executive Order GA-15, April 21, 2020

Texas Medical Board (TMB) Frequently Asked Questions (FAQs) Regarding Non-Urgent, Elective Surgeries and Procedures During Texas Disaster Declaration for COVID-19 Pandemic, April 21, 2020

Utah

State Issues Public Health Order Allowing Hospitals and Physicians to Resume Some Elective Surgeries, April 22, 2020

STATE PUBLIC HEALTH ORDER, April 21, 2020

Utah Hospital Roadmap for Resuming Elective Procedures, April 21, 2020

Vermont

Executive Order No 01-20 – Amendment to Addendum 3, May 4, 2020: ...authorize the Commissioner of the Vermont Department of Public Health to issue mitigation requirements and procedures for the resumption of clinic visits, diagnostic imaging and such outpatient surgeries and procedures that have a minimal impact on inpatient hospital bed capacity and PPE levels, including those performed in the office or ambulatory surgical care setting

The Commissioner of the Department of Public Health, with the approval of the Governor, may, from time-to-time, update and modify the mitigation requirements and procedures regarding the resumption of additional adult elective surgery and medical and surgical procedures, including dental procedures

Virginia

Article, April 27, 2020 Governor Northam announced the state is working on plans to resume elective surgery as early as May 1.

VDH COVID-19 Interim Guidance for Offering Inpatient or Outpatient Elective Procedures, May 4, 2020

Washington

Press Release, April 29, 2020, guidance to clarify limits on elective surgeries

Interpretive Statement Related to Proclamation by the Governor 20-24, Restrictions on Non-Urgent Medical Procedures

Proclamation by the Governor Reducing Restrictions on, and Safe Expansion of, Non-Urgent Medical and Dental Procedures, May 18, 2020

West Virginia

Executive Order 30-20, April 27, 2020

Instructions to Resume Elective Medical Procedures, April 21, 2020

West Virginia Strong – The Comeback April 27, 2020 slide deck (Unveiling The Comeback plan)

April 28, 2020 slide deck (Additional Clarifications)