Louisiana Will Loosen Restrictions on Non-Emergency Healthcare Services Starting April 27, 2020

The Louisiana Department of Health (LDH) has issued multiple directives significantly restricting non-emergency healthcare services in light of the COVID-19 crisis. The limitations have been reinforced by additional directives from the Louisiana State Board of Medical Examiners emphasizing the importance of discontinuing services and by the Louisiana Attorney General who launched a COVID-19 Task Force to enforce LDH restrictions on providers.

This week, LDH released a directive to all Louisiana healthcare facilities and professionals relaxing restrictions on non-emergency healthcare services, focusing on (1) Medical and Surgical Procedures, (2) Dental Procedures, and (3) Other Healthcare Services. The order becomes effective on Monday, April 27th, 2020 at 12:01am.

I. MEDICAL & SURGICAL PROCEDURES

Currently, in light of COVID-19, medical and surgical procedures can only be provided for an emergency medical condition or where needed to avoid further harms from an underlying condition or disease. On Monday, April 27, 2020, providers will also be able to perform surgeries/procedures for Time Sensitive Medical Conditions where all of the following conditions are met:

  • The provider conducts a preoperative evaluation to determine whether the patient has COVID-19, including testing where available.
  • The patient practices strict social distancing from the time of evaluation until the procedure/surgery.
  • The facility has at least a 5 day supply of Personal Protective Equipment (PPE) on hand (the facility cannot rely on the government for the supply).
  • The facility has an adequate supply chain for medical equipment, supplies and medications.
  • The facility has adequate medical & support staff to meet the needs of all patients
  • The facility constantly monitors hospital, regional, and state resources and ESF-8 reports showing COVID-19 burden/impact.
  • The facility or provider contacts the patient within 10-14 days after the procedure to check for COVID-19.
  • The facility/provider complies with CMS recommendations and guidance including that of 4/19/2020 regarding Re-opening Facilities to Provide Non-Emergent, Non-Covid-19 Healthcare: Phase I (available here: https://www.cms.gov/files/document/covid-flexibility-reopen-essential-non-covid-services.pdf)
  • If a delay in a procedure will not adversely affect the patient, it should still be postponed.

However, the State Health Officer can immediately issue a notice to discontinue surgeries/procedures for time sensitive medical conditions if there are shortages in ventilators, ICU beds, or med/surg beds due to the number of new admit COVID-19 cases or based on any other criteria he deems appropriate.

II. DENTAL VISITS, PROCEDURES AND SURGERIES

Similarly, dental visits, procedures and surgeries currently can only be provided for an emergency medical condition or where needed to avoid further harm from an underlying condition or disease. On Monday, April 27, 2020,, dental providers will also be able to treat for Time Sensitive Medical Conditions where all of the following conditions are met:

  • The facility and/or healthcare provider ensures that algorithms from the American Dental Association (attached to the LDH directive, available at the link below) and Guidelines from the Center for Disease Control are followed for screening and treating patients.
  • The facility or provider contacts the patient within 10-14 days after the procedure to check for COVID-19.
  • If a delay in a procedure will not adversely affect the patient, it should still be postponed.

Here too, the State Health Officer may discontinue these services if there are shortages, an increase in the number of new admit COVID-19 cases or based on other appropriate criteria.

III. Healthcare Services, Other than Medical and Surgical Procedures

Healthcare providers were previously directed to transition all in-person healthcare services to telehealth where medically appropriate and to postpone all in-person healthcare services that could safely be postponed for 30 days. The newest LDH directive has loosened these restrictions and now allows for the following:

  1. Providers should still offer telehealth rather than an in person visit when medically appropriate and the same standard of care can be met. Providers who have legitimate and valid barriers to telehealth delivery, who may not be able to shift all services to telehealth and who are acting in good faith shall not be found to be in violation of this directive.
  2. In person healthcare services should be postponed when, in the provider’s best medical judgment, patient outcomes will not be compromised.
  3. The facility/provider must contact the patient within 10-14 days to check for COVID-19.
  4. The facility/provider should comply with CMS recommendations and guidance including that of 4/19/2020 regarding Re-opening Facilities to Provide Non-Emergent, Non-Covid-19 Healthcare: Phase I

A full copy of LDH Healthcare Facility Notice #2020-COVID19-ALL-010 is available here http://ldh.la.gov/assets/oph/Coronavirus/resources/providers/LDH-MEMO-UPDATE-RESTORE-MED-SURG-Procedures.pdf

Written By: Emily Black Grey

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