In response to the growing threats to Hoosiers caused by the COVID-19 pandemic, Governor Holcomb issued an executive order on March 30, 2020 with directives allowing flexibility for hospitals and health care professionals responding to the public health emergency declared by Governor Holcomb on March 2, 2020.
The directive permits the Commissioner of the Indiana State Department of Health to direct the opening, staffing, equipping and use of temporary facilities for patient care when the Commissioner has determined patient capacity has exceeded "what is available or needed." The order temporarily suspends the need for a temporary facility to obtain a hospital license, allows the primary hospital pharmacy to supply the temporary facility without obtaining a remote facility permit, waives the requirement for a standalone pharmacy to have a license at a temporary facility, allows for Medicaid reimbursement for services provided at the temporary facility and requests that health insurers provide coverage for services provided at temporary facilities.
To assist in easing the burden on overwhelmed health care facilities and providers, the directive permits certain types of health care professionals without active licenses in Indiana to provide health care services in the state during the public health emergency without seeking reinstatement or approval by the relevant licensing board. This includes health care professionals who have retired within the past five years or who have surrendered their licenses (not revoked, suspended or relinquished) or have inactive licenses. It also allows certain licensing boards to issue permits or licenses to the following types of students. These licenses or permits are to be valid for up to 90 days during the public health emergency and may be renewed in 30-day increments as needed.
- A medical student in his or her last semester of a 4-year program or who has completed a 4-year accredited program within the last 90 days may be issued a limited scope temporary medical permit to practice under the indirect supervision of a licensed physician.
- Medical residents who are current holders of a post-graduate training permit and who are enrolled in an accredited residency program may be granted the authority to practice under a full medical license without supervision at the order of the State Health Commissioner.
- The requirements for completing criminal background checks and taking the national certifying exam are suspended for physician assistant students who have completed all required course work at an accredited school and who have applied for a license with the licensing board. These students may obtain a temporary license to practice as a physician assistant.
- Similar to the licensure requirements for physician assistants, nursing students who have completed course work at an accredited school and have applied for a license with the nursing board may have the requirements for a criminal background check and having taken the NCLEX exam waived in order to obtain a temporary nursing license.
- Respiratory care practitioner students having completed all course work at an approved school and applied for a license with the board may be issued a temporary license to practice as a respiratory care professional without undergoing the criminal background check or completing the required licensing or certification exam.
In an effort to preserve personal protective equipment (PPE) for health care providers on the front lines of caring for patients infected with the COVID-19 virus, the executive order directs all health care providers, whether medical, dental or other, and all health care facilities of any type (including abortion facilities) to cancel or postpone elective or non-urgent surgical or invasive procedures if such surgical or invasive procedure would add to the depletion of the hospital's capacity needed and available to cope with the COVID-19 pandemic or utilize PPE (except gloves) in any way. "Elective and non-urgent" procedures are defined as those which can be delayed without undue risk to the current or further health of the patient as determined by the patient's health care provider. Veterinarians are also directed to cancel or postpone such procedures under the same conditions.
The directive also waives the prohibition against audio-only telemedicine services and allows for physical, speech and occupational therapists to provide telemedicine services, but only when using secure videoconferencing, interactive store and forward technology or remote patient monitoring technology. In addition, those DEA-registered providers who have not conducted an in-person medical evaluation of a patient may issue a prescription to that patient for any schedule II-V controlled substance as long as the prescription is issued for a legitimate medical purpose, the telemedicine communication is conducted using an audio-visual, real-time, two-way interactive communication system and all other applicable state and federal laws are followed. The Indiana Department of insurance is directed to request health insurers to provide coverage for expanded telemedicine services.
The executive order may be viewed at https://www.in.gov/gov/2384.htm