HAP Resource Center

Fact Sheet: COVID-19 Emergency Health Care Flexibilities

Issue Overview

In response to the COVID-19 pandemic, Governor Wolf issued a disaster declaration that allowed state agencies to waive certain regulations so that hospitals could quickly respond during the public health emergency.

During May, voters supported an amendment to the state constitution to limit disaster declarations to 21 days and allow the General Assembly to terminate the disaster declaration. Lawmakers ended the declaration during June and extended COVID-19 waivers until September 30, 2021.

Because of the efficiencies that resulted from easing these regulations, Pennsylvania hospitals are urging state legislators to protect pandemic-era reforms that have benefited all Pennsylvanians by:

  • Expanding telehealth services
  • Making vaccines easier to get at pharmacies
  • Removing licensing barriers that aggravate staffing shortages
  • Allowing hospitals to quickly adapt to emergencies by altering their space as necessary to care for influxes of patients

Why This Is Important

In response to COVID-19, hospitals and health care providers quickly pivoted to provide critical health care services during a global crisis. Now, more than a year into the pandemic, hospitals and their staff have come to rely on these health care flexibilities to care for patients.

The lawmaking and regulatory processes cannot move quickly enough to avoid confusing, expensive, and potentially dangerous gaps in current health care practice if all health care waivers expire as scheduled. Failure to preserve emergency health care flexibilities will result in:

  • Fewer medical providers in a workforce already strained by staff shortages and pandemic conditions
  • Less flexibility in places to receive health care
  • Loss of access to proper care for Pennsylvanians

These flexibilities are needed to protect the health of Pennsylvanians and the resiliency of our front line health care providers, especially as new challenges threaten the health care community’s response, including new and highly contagious COVID-19 variants, staff shortages, increased emergency room visits, and an upcoming flu season. Now is not the time to put up more barriers for providing and accessing health care across the state.

In Detail

Pennsylvania hospitals are calling for the following emergency flexibilities to be preserved. While hospitals are seeking a blanket waiver extending all pandemic emergency health care flexibilities, some individual flexibilities are addressed by proposed legislation as noted.

Mother and son using telehealth for medical careTelehealth Licensure and Reimbursement

Licensed health care professionals can provide services—including routine care, telepsychiatry, and some acute care—using telehealth. Pennsylvanians can feel safe knowing that their treatment online or over the phone will be covered by insurance or medical assistance.

If it Goes Away:

  • Telehealth services and reimbursement may be at risk
  • Decreased service offerings could result in more specialty shortages
  • Payment for telehealth services will not be the same as in-person services
  • Patient access to care will decrease, especially for those who cannot easily access transportation, those living with disabilities, those living in rural environments, or for the elderly

Related legislation: Senate Bill 705

Pharmacies and Vaccines

Vaccine shots available at pharmaciesPharmacists can:

  • Provide flu vaccinations to individuals ages 3 years and up
  • Administer the COVID-19 vaccine without an order from a licensed prescriber or a protocol authorized by a physician, so long as it’s done according to emergency use authorization (EUA) standards
  • Under certain circumstances, delegate vaccine authority to others including pharmacy interns—under direct supervision of a licensed pharmacist and other licensed health care professionals whose scope of practice includes the administration of injectables (LPNs, RNs, physicians, physician assistants, pharmacy technicians, etc.)

If it Goes Away:

  • Pharmacists will only be able to vaccinate individuals age 18 and older. This will slow vaccination efforts overall, especially for children ages 12 and up when COVID-19 vaccines receive EUA or U.S. Food and Drug Administration approval
  • Nurses and physicians will be required to give vaccines, diverting time from direct clinical care
  • Access to safe and effective vaccines will decrease for Pennsylvanians

Related legislation: House Bill 1535 and Senate Bill 511

Emergency Operations

Hospitals use alternative space to care for patients as long as it is in the Emergency Operation Plan and the Pennsylvania Department of Health is notified.

If it Goes Away:

  • Hospitals will not be allowed to alter space to care for influxes of patients
  • Facilities may run out of space more quickly to treat seriously ill patients           

Hospital staff moving beds to make room for more patientsCertified Registered Nurse Practitioner (CRNP) Scope of Practice

CRNPs can work with multiple physicians in the same health system that holds their primary practice agreement.

If it Goes Away:

  • CRNPs lose flexibility to spend more time treating Pennsylvanians instead of doing paperwork that restricts their ability to care for additional patients in the same facility
  • The clinician shortage will be more acute and patients will lose access to needed specialists

Related legislation:  Senate Bill 25

Physician Scope of Practice

Physicians at teaching hospitals can teach and practice at more than two facilities within the same health system.

If it Goes Away:

  • Doctors will be limited to only two facilities in a system
  • The clinician shortage will be more acute and patients will lose access to needed specialists

Physician Assistant (PA) Scope of Practice

PAs can practice immediately upon filing an executed supervision agreement with a physician practice, and physicians can supervise more PAs.

If it Goes Away:

  • Decreased flexibility for health care facilities, physician assistants, and physicians
  • Less access to health care services for patients

Related Legislation:  Senate Bill 397 and Senate Bill 398



Topics: Emergency Preparedness, Public Health, Regulatory Advocacy, State Advocacy, Telehealth, Workforce

Revision Date: 9/16/2021

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