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Evolving Article: CORONAVIRUS (COVID-19) IN THE CHIROPRACTIC OFFICE

Sunday, April 26, 2020  
Posted by: Rachel Wendt
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Quick Link Resources:

Colorado Department of Public Health and Environment COVID-19 Updates
Centers for Disease Control and Prevention/CDC COVID-19 Updates
CDC Reporting Protocols for COVID-19
OSHA Control and Prevention Resources 
OSHA Guide: Preparing Workplaces for COVID-19
Colorado Department of Education School Resources
CMS FAQ Fact Sheet
Gov. Polis Press Releases
Colorado Live Blog Updates on Coronavirus

DIRECTORY OF LOCAL HEALTH DEPARTMENTS

Resources:

Small Business Disaster Loan Assistance
Disaster Loan Application Form

Webinars:
-COVID-19: What Employers Need to Know About the Families First Coronavirus Response Act
-Strategy for your COVID-19 Response
-SBA Disaster Relief/TaxCredits & Rebates for Chiropractors
-Implementing Telehealth for Chiropractic 

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Editors Note: This article is being constantly updated as new information is made available. Please continue checking this article for updates.

 

In the last few days, our nation and the entire world are coming to terms with the unprecedented health and business impact of Coronavirus. At the CCA, we have never been more acutely aware that many chiropractors operate as solo practitioners or small businesses who may feel more isolated than large group practitioners. 

In addition to providing information updates, the CCA believes it is just as important that we serve as a bridge to remind members that our chiropractic community is strong and that we are here to help in any way we can. The CCA continues to work to stay abreast of developments and to share them with our members.

UPDATE 4/27/2020 5:00PM
 
WE'VE CREATED A NEW PAGE FOR THE NEXT "SAFER-AT-HOME" PHASE. 

CLICK HERE TO VIEW OUR NEW "SAFER-AT-HOME" PAGE OR VISIT OUR "SAFER-AT-HOME" PAGE UNDER THE LATEST NEWS ON OUR HOMEPAGE.

 

UPDATE ON RESOURCES FOR CHIROPRACTIC OFFICES [4/9/2020 7:30PM]

We have compiled many downloadable and customizable resources for docs. Please visit our page here: https://www.coloradochiropractic.org/page/COVID-19 Note - you must be logged in as a CCA member to download these documents!

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GOV POLIS ISSUES SAFER AT HOME EXECUTIVE ORDER [UPDATED 4/26/2020 10:00PM]

 

On Sunday, April 26, 2020 Governor Polis issued Executive Order D2020 044 Safer at Home and Executive Order D2020 045 Permitting the Limited Recommencement of Voluntary or Elective Surgeries and Procedures in Colorado. 

 

Our team is currently reviewing the two latest Executive Orders and will have more information on Monday. 

 

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UPDATED STAY AT HOME ORDERS FOR COUNTIES [UPDATED 4/25/2020 12:00PM]

Updated stay-at-home orders

 

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UPDATE FOR CHIROPRACTORS [UPDATED 4/24/2020 4:00PM]

 

Executive Orders D2020 017/024 “Ordering Coloradans to Stay at Home Due to the Presence of COVID-19 in the State” and Executive Orders D2020 009/027 “Ordering the Temporary Cessation of All Elective and Non-Essential Surgeries and Procedures and Preserving Personal Protective Equipment and Ventilators in Colorado Due to the Presence of COVID-19” are set to expire on April 26, 2020. The Colorado Chiropractic Association has been in constant contact with the Governor’s office and we are anxiously awaiting the precautions chiropractic offices will have to implement next week.

 

The precautions from the Governor’s office are set to be released as late as Monday, April 27, 2020. Many businesses in Colorado are also currently waiting to see what these precautions will be. We will send out a follow up email as soon as we know more.

 

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UPDATE TO COUNTY STAY AT HOME ORDER [UPDATED 4/24/2020 11:00AM]

 

Both Executive Order D2020 017 “Ordering Coloradans to Stay at Home Due to the Presence of COVID-19 in the State” and Executive Order D2020 009/027 “Extend the Temporary Cessation of All Elective and Non-Essential Surgeries and Procedures and Preserving Personal Protective Equipment and Ventilators in Colorado Due to the Presence of COVID-19” are set to expire on April 26, 2020. The Colorado Chiropractic Association has been anxiously awaiting further precautions and guidelines to be released. We will send out more information as information becomes available.

 

Denver: On April 24, 2020, Denver Mayor Hancock announced the extension of the Denver Stay-at-Home order until May 8, 2020. We will post the official order when it is posted online. Find updates here: https://www.denvergov.org/

 

Boulder April 24, 2020: Along with other local public health agencies in the region, Boulder County Public Health will extend the Colorado Stay-At-Home order until May 8 in order to develop clear strategies and guidelines to prevent a surge of COVID-19 cases when our community moves to the “Safer at Home” phase. There is one important difference between the statewide Stay-at-Home order and the Boulder County extension. Beginning on April 27, any non-critical businesses may offer curbside delivery of products and travel to pick up these goods will be considered necessary travel. For updates, click here: https://www.bouldercounty.org/families/disease/covid-19/ Boulder specifically states “All persons and businesses in Boulder County are ordered to continue abiding by the requirements of Colorado’s Stay-At-Home orders through midnight on May 8, 2020, even though those orders as issued by the State would otherwise expire on April 26, 2020. By this Order, I hereby adopt all terms and conditions of Colorado’s Stay-At-Home Orders, Executive Order D 2020-024 and Public Health Order 20-24 as updated." Chiropractors are again listed as a critical business, however we must still comply with Executive Order 009/027 through April 26th. Stay tuned regarding the status of Executive Order D2020 009 (as mentioned above).

Jefferson County: Jefferson County Public Health has issued a public health order extending the state’s Stay-at-Home order in Jefferson County through May 8, 2020, with a key revision to support non-Critical businesses. The key difference between the statewide Stay-at-Home order and the Jefferson County extension, though, is the allowance for non-Critical Businesses to begin to offer curbside delivery of products. Additionally, travel to pick up these goods is now included in the definition for necessary travel. Full announcement here: https://www.jeffco.us/4030/Stay-At-Home-Order. In Jefferson County, critical businesses are allowed to remain open. JCPH specifically references the Department of Regulatory Agencies’ Critical Business list for who can remain open, which includes chiropractors, however we must still comply with Executive Order 009/027 through April 26th. Stay tuned regarding the status of Executive Order D2020 009 (as mentioned above).

 

It looks as though counties are implementing Stay-at-Home orders on their own. We will continue to track their orders on a county-by-county basis. Click here for a list of all counties.

 

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UPDATE TO DENVER STAY AT HOME ORDER [UPDATED 4/23/2020 8:00PM]

 

DENVER — The city of Denver is extending stay-at-home order until at least May 8, 9Wants to Know has confirmed.

 

Denver Mayor Michael Hancock is expected to make a formal announcement Friday morning at 10:00am. (https://www.9news.com/article/news/health/coronavirus/metro-agencies-discussing-stay-home-order-extension-coffman-says/73-8c48f2c7-f554-4f2a-92bf-bc5a59d952ed)

 

We will not know what is in the order until the announcement April 24. Please stay tuned.

 

GOV POLIS UPDATES TO COLORADO STAY AT HOME ORDER [UPDATED 4/21/2020 4:00PM]

The article below is a press release as of Monday, April 20, 2020. As of now, the stay-at-home order is not being extended for the state of Colorado. During the press conference on Monday, April 20th, Gov. Polis stated some businesses will be able to open - with restrictions. We are currently waiting to see what these restrictions are and how they will impact your practice. Examples of restrictions include, but are not limited to, doctors and staff to wear masks, social distancing requirements and no more than 10 people in an area at a given time. - again these are examples right now. As soon as we know more of what these restrictions will look like, we will send an email and post on our website here.

Find the original press release, and all Gov. Press releases here: 
 
https://www.colorado.gov/governor/news

DENVER - Today Governor Jared Polis discussed modeling data that shows how Coloradans are doing their part during the stay-at-home order and what next steps will look like as health and safety restrictions change in the coming days and weeks. 

“Coloradans in every corner of our state have stepped up and taken responsible steps to help bend the curve of this pandemic and we are grateful for these shared efforts that helped save lives and slow the spread. The deadly virus will continue to be with us, and we must wear masks and socialize less to avoid its rapid growth. For seniors and those with pre-existing conditions, it’s important to stay home whenever possible through May. Though we are moving into a sustainable way of living during this pandemic, there are tough days ahead,” said Governor Jared Polis. “This is a marathon - not a sprint, which was the easy part - now we need to pace ourselves and these distancing measures need to be sustainable. We’re going to have to learn to live with coronavirus for a while, but we must live not with anxiety or fear, but with extreme caution, especially if you are a member of a vulnerable population. I am thrilled that we are on the path to a sustainable way of living more safely, but that doesn’t mean there isn’t the potential that we have to return to a more cautious approach if the state sees a spike in new cases.” 

The Governor discussed new modeling showing the state will not need to extend the Stay-at-Home order that is set to expire at the end of the week, but will need to continue a variety of long-term social distancing measures. The modeling shows that the Stay-at-Home order has reduced social interactions by 75-80% since it went into effect. Currently, Colorado has 10,000 reported cases, however, the state believes the real number is closer to 65,000-75,000 Coloradans -- about 1.1%-1.3% of the population.

There are three levels of social distancing, which include: Staying at Home, Safer at Home, and Protect our Neighbors. On April 27, the state will be moving onto the Safer at Home phase. During this phase Coloradans will no longer be ordered to stay home, but are still strongly encouraged to do so. Vulnerable populations and seniors must continue staying home except when absolutely necessary and K-12 school districts and postsecondary institutions will continue to suspend normal in-person instruction until the end of the school year.  

It’s important to note that there may be a fluctuation between the levels to recover from outbreaks, meaning that Colorado could return to the Stay-at-Home phase if there is a significant increase in cases or spread of the virus.

Local governments will have the opportunity to implement stricter restrictions, particularly those who may be experiencing an outbreak. 

For more details on what the Safer at Home phase of the pandemic looks like, please view the Governor’s presentation here

The latest Colorado model report is now available to the public.

Watch the Governor’s news conference here. To stay up to date, visit COVID19.Colorado.gov

 

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GOV POLIS ISSUES EXECUTIVE ORDER REQUIRING CRITICAL BUSINESSES TO WEAR NON-SURGICAL MASKS [UPDATED 4/17/2020 12:00PM]

 

On Friday, April 17, 2020 Gov Polis signed Executive Order D 2020 039 Ordering Workers in Critical Businesses and Critical Government Functions to Wear Non-Medical Face Coverings which is in effect for 30 days. Read the full Executive Order D2020 039 here. Remember, per DORA's directives, chiropractors are considered Critical Businesses and those that choose to remain open in compliance with Executive Order D2020 009 and 027, must now wear a non-medical face covering. 

 

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UPDATE REGARDING DORA'S EMAIL SENT APRIL 16, 2020 [UPDATED 4/20/2020 12:00PM]

 

RE: Executive Order aids student nurses, CNAs; expands workforce during crisis

On April 15, 2020, Governor Polis signed Executive Order D2020 038 titled Ordering the Temporary Suspension of Certain Statutes and Rules to Expand the Healthcare Workforce for Hospitals and Other Inpatient Treatment Facilities Due to the Presence of COVID-19. Original email at the bottom of this page.

 

This Executive Order allows for the scope of practice to be expended only for those that work in a hospital or “inpatient facilities.”  Meaning if a chiropractor were on staff at a hospital or inpatient facilities, that chiropractor could perform beyond the scope of practice as long as they were supervised. 

 

This Executive Order does not change previous orders currently still in place. The Executive Orders pertaining to “The Temporary Cessation of all Elective and Non-Essential Surgeries and Procedures and Preserving Personal Protective Equipment and Ventilators in Colorado Due to the Presence of COVID-19” (Executive Order D 2020 009 and D 2020 027) and “Ordering Coloradans to Stay at Home Due to the Presence of COVID-19 in the State” (Executive Orders D 020-017 and D2020-024) are all still in place and currently set to expire on April 26, 2020.

 

We again encourage you to check with your malpractice insurance should a chiropractor work in a hospital or "inpatient facility".

 

For more information, please read the Executive Order Question and Answer document regarding EOD2020 038.

 

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UPDATE REGARDING COLORADO UNEMPLOYMENT [UPDATED 4/17/2020 2:30PM]

 

Update as of April 17, 2020: On April 20, 2020, Colorado Unemployment will begin taking unemployment benefit applications under the CARES Act (Coronavirus Aid, Relief, and Economic Security Act), paying the additional $600 per week in unemployment benefits and launch other new points of access for unemployed workers to obtain information. Claimants do not need to take action to receive the additional $600 weekly benefit amount. 

 

Further - beginning April 20, 2020, gig workers and independent contractors can begin applying for unemployment.Self-employed and gig workers: you will need to provide either a 2018 or 2019 tax return as part of your application. More information will be posted on the unemployment page as it becomes available.

 

If you were a traditional employee in the last 18 months whose employer took taxes from your paycheck, you should file a regular unemployment claim.

If you are unemployed and in the last 18 months were self-employed and responsible to pay taxes on your income, you should file for expanded unemployment benefits called Pandemic Unemployment Assistance

LEARN MORE HERE: https://www.colorado.gov/pacific/cdle/unemployment

 

  

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TELEHEALTH ENCOURAGED DURING THESE TIMES [UPDATED 4/14/2020 10:00AM]

 

Governor Polis issued Executive Order D 2020 020 Ordering the Temporary Suspension of Certain Statutes to Expand the Use of Telehealth Services Due to the Presence of COVID-19 on April 1, 2020. The Department of Regulatory Agencies subsequently sent an email on April 13, 2020 further clarifying this executive order.

 

DORA’s email states:

 

"1. Which DORA-regulated professions fall under Executive Order D 2020 020?

 

Executive Order D 2020 020 explicitly mentions suspension of statutes related only to mental health and veterinary services providers. Nevertheless, the following healthcare professions also are able and encouraged to use telehealth in treatment of patients for the duration of this health emergency. Please note that, with the exception of veterinarians, providers must meet the definition outlined in Colorado Revised Statutes §10-16-102(56), which includes those “licensed or otherwise authorized to furnish healthcare services” as defined in §10-16-102(33). (emphasis added)

[…]

·      Chiropractic […]"

 

The full email is at the bottom of this page.

 

We encourage everyone to review the provider-related guidance regarding telehealth created by the Colorado Department of Public Health and Environment here. Be sure to check with each insurance company you are in network with to ensure coverage and if each insurance company has their own requirements.

 

Should a provider feel telehealth is not sufficient to address the needs of your patients, you must still adhere to Executive Order D 2020 027 (the amended version of Executive Order D 2020 009) as well as the social distancing requirements in Amended Public Health Order 20-24.

 

 

UnitedHealthcare’s Telehealth Services Outpatient for Chiropractic Services 

 

“Must use live video-conferencing that involves the presence of both parties at the same time and a communication link betwee
n them that allows a real-time audio and visual interaction to take place.”

 

UHC Specific code list for chiropractors

 

We are currently researching other insurance networks and will post when more information becomes available.

 

 

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UPDATE CARES ACT PROVIDER RELIEF FUND [UPDATED 4/10/2020 12:30PM]

CARES Act Provider Relief Fund

President Trump is providing support to healthcare providers fighting the COVID-19 pandemic. On March 27, 2020, the President signed the bipartisan CARES Act that provides $100 billion in relief funds to hospitals and other healthcare providers on the front lines of the coronavirus response. This funding will be used to support healthcare-related expenses or lost revenue attributable to COVID-19 and to ensure uninsured Americans can get testing and treatment for COVID-19.

 

According to DHHS: “Recognizing the importance of delivering funds in a fast and transparent manner, $30 billion is being distributed immediately – with payments arriving via direct deposit beginning April 10, 2020 – to eligible providers throughout the American healthcare system. These are payments, not loans, to healthcare providers, and will not need to be repaid.

All facilities and providers that received Medicare fee-for-service (FFS) reimbursements in 2019 are eligible for this initial rapid distribution. Providers will be distributed a portion of the initial $30 billion based on their share of total Medicare FFS reimbursements in 2019. Total FFS payments were approximately $484 billion in 2019. The automatic payments will come to providers via Optum Bank with "HHSPAYMENT" as the payment description.

 

READ MORE HERE: https://www.coloradochiropractic.org/news/499759/Resources-for-COVID-19.htm 

VISIT HHS WEBSITE HERE: https://www.hhs.gov/provider-relief/index.html

 

 

More details will be released as they become available.

 



UPDATE GOVERNOR POLIS STAY AT HOME ORDER EXTENDED THROUGH APRIL 26, 2020 [UPDATED 4/7/2020 5:00PM]

 

As of Monday, April 6, 2020, Governor Polis extended Executive Order D 2020 017, the stay-at-home order, to end Sunday April 26, 2020 (Executive Order D 2020 024).

Further, the Governor extended Executive Orders on the temporary suspension of elective and non-essential surgeries and procedures, (original Executive Order D 2020 009, now Executive Order 2020 027). This new order is set to expire on April 26, 2020. 

 

The Board of Directors of the Colorado Chiropractic Association recognizes there has been a lot of confusion following the Department of Regulatory Agencies statement on Prohibition of Chiropractic Elective Care Procedures released on March 27, 2020. DORA has since released an additional clarifying statement on April 2, 2020.  Some chiropractors interpret these statements as a directive to close your practice. We continue to disagree with that conclusion. After consultation with the CCA’s attorneys, lobbyists, and other professional medical associations, we are providing the following information to assist you making a decision how best to proceed with your practice for the duration of the Governors Order.

Per Executive Orders 2020 009 and 027, all chiropractic practices must postpone/ reschedule performance of elective care including, but not limited to, asymptomatic care, preventative care, non-medically necessary care or ancillary in-office services (such as non-therapeutic massage or other services).

Acute or emergency care, that falls under the guidance of Executive Order 2020 009 and 027 can be administered and should be done in accordance with other current executive orders issued by Governor Polis, local county orders and CDC guidelines.

DORA’s notice on April 2, 2020:

“We are asking for all healthcare professionals to assess the essential need to provide services on a case-by-case, patient-by-patient basis to ensure compliance with the Order. To make your assessment, you need to consider that the only procedures or surgeries that are permissible under this Order are those that address the following:

·       There is a threat to the patient's life if the surgery or procedure is not performed;

·       There is a threat of permanent dysfunction of an extremity or organ system of the surgery or procedure is not performed;

·       There is a risk of metastasis or progression of staging of a disease or condition if the surgery or procedure is not performed; or

·       There is a risk that the patient's condition will rapidly deteriorate if the surgery or procedure is not performed and there is a threat to life, or to an extremity or organ system or of permanent dysfunction or disability.

As the March 27th guidance indicated, Executive Order D 2020 009 does allow for the discretion of the provider to conduct a chiropractic procedure in those circumstances where an injury or illness is at risk of progression or the patient’s health is at risk of rapid deterioration. You will note that DORA has also listed chiropractors as a critical service, provided that the services performed are within these confines of the Executive Order and are a conservative assessment of procedures that are critical on a case-by-case basis.”

 

Each office choosing to still see acute or emergency patients must put in place a system for patients that may need “acute or emergency” treatment including but not limited to, a method to contact the chiropractor over the phone to determine if an in-patient procedure is necessary, pre-screening patients, maintaining social distancing and CDC prevention and safety precautions. We have a COVID-19 compliance manual available to our members as a member benefit that you can customize to your office. Visit our page here to download your customizable compliance manual.

While it is understood that wellness care can aid in optimal health and function of the patient, to avoid potential exposure and community threat, we urge each chiropractor to consider the potential risks to public health.

We will continue to catalog more resources and updates on our website here: https://www.coloradochiropractic.org/news/493743/Evolving-Article-CORONAVIRUS-COVID-19-IN-THE-CHIROPRACTIC-OFFICE.htm and https://www.coloradochiropractic.org/news/499759/Resources-for-COVID-19.htm

 

 

Disclaimer - The Colorado Chiropractic Association is a professional association advocating for the rights of chiropractors and their patients across the state of Colorado. We are NOT a state agency or regulatory body. We are merely informing our membership regarding our understanding of what they are allowed to do during this difficult and confusing time. We are neither requiring nor recommending to you to keep your doors open nor requiring nor recommending to you to close your office at this time as we as an association cannot make this decision for you.  Should you have additional questions or concerns, we encourage you to seek independent legal advice.

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UPDATE DORA'S GUIDANCE FOR CHIROPRACTORS [UPDATED 4/6/2020 1:42PM] 

Having trouble viewing this email?View it as a Web page.

CO DORA DPO Color Logo Lock Up

Guidance for Chiropractic Procedures

Dear Chiropractic Licensee:

The State recognizes this is an unprecedented and difficult time for Coloradans. We are making every effort to ensure that all Coloradans are safe and receive the best possible care over the next weeks and months.

Governor Polis issued Executive Order (EO) D 2020 009(Order) to prioritize essential healthcare services, to help ensure access to necessary personal protective equipment and other medical supplies and notably in light of more recent actions, to promote safe personal distancing to reduce putting individuals at great risk of contracting COVID-19.

We are asking for all healthcare professionals to assess the essential need to provide services on a case-by-case, patient-by-patient basis to ensure compliance with the Order. To make your assessment, you need to consider that the only procedures or surgeries that are permissible under this Order are those that address the following:

  • There is a threat to the patient's life if the surgery or procedure is not performed;
  • There is a threat of permanent dysfunction of an extremity or organ system of the surgery or procedure is not performed;
  • There is a risk of metastasis or progression of staging of a disease or condition if the surgery or procedure is not performed; or
  • There is a risk that the patient's condition will rapidly deteriorate if the surgery or procedure is not performed and there is a threat to life, or to an extremity or organ system or of permanent dysfunction or disability.

As the March 27th guidance indicated, Executive Order D 2020 009 does allow for the discretion of the provider to conduct a chiropractic procedure in those circumstances where an injury or illness is at risk of progression or the patient’s health is at risk of rapid deterioration. You will note that DORA has also listed chiropractors as a critical service, provided that the services performed are within these confines of the Executive Order and are a conservative assessment of procedures that are critical on a case-by-case basis.

We recognize this is a difficult time, but we are asking all our professionals to comply with this order so that the spread of virus and the risk to our population is mitigated wherever possible. Thank you.

 

Do not reply to this email - this is not a monitored inbox.

CO DORA DPO White Logo Lock Up

 

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UPDATE DEPARTMENT OF HOMELAND SECURITY LIST DOCTORS OF CHIROPRACTIC AS ESSENTIAL [UPDATED 3/30/2020 5:30PM]
Update - Department of Homeland Security (DHS) Lists Doctors of Chiropractic as Essential (See top of Page 5) - full link: https://www.cisa.gov/sites/default/files/publications/CISA_Guidance_on_the_Essential_Critical_Infrastructure_Workforce_Version_2.0_Updated.pdf?fbclid=IwAR0Dfzx7vAxfc_exCd-xXQjaZP-DTbEI49R-y0aoU8CDWcT6uEjpPp4kOWE

"This list is advisory in nature. It is not, nor should it be considered, a federal directive or standard. Additionally, this advisory list is not intended to be the exclusive list of critical infrastructure sectors, workers, and functions that should continue during the COVID-19 response across all jurisdictions. Individual jurisdictions should add or subtract essential workforce categories based on their own requirements and discretion."

Doctors must still comply with state and local regulations regarding their practice.

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UPDATE DORA'S GUIDANCE ON CRITICAL VS. NON-CRITICAL BUSINESS PROFESSIONS [UPDATED 3/29/2020 10:00AM]

The Board of Directors of the Colorado Chiropractic Association recognizes there has been a lot of confusion following the Department of Regulatory Agencies statement on Prohibition of Chiropractic Elective Care Procedures released on March 27, 2020.  Some chiropractors interpret the statement as a directive to close your practice. We disagree with that conclusion. After consultation with the CCA’s attorneys, lobbyists, and other professional medical associations, we are providing the following information to assist you making a decision how best to proceed with your practice for the duration of the Governors Order.

The Governor’s office released Executive Order 2020 009 on March 19, 2020 and to date; this Executive Order has not been amended. This order is in effect until April 14, 2020.

Late on March 27th, the Colorado Department of Regulatory Agencies released guidance on “Critical vs. Non-Critical Business Professions” (original post here and posted under DORA's Updates for Licensees here). The guidance states:

 “Critical Professions” Under DORA’s Purview (Note: The following professions must still adhere to the mandates in Executive Order D 2020 009 prohibiting elective, non-emergency procedures**, as well as the social distancing requirements in Amended Public Health Order 20-24, and apply telehealth practices as recommended by the Colorado Department of Public Health and Environment (CDPHE) where possible):


·       “[…]Chiropractic (ONLY if adhering to Executive Order D 2020 009 prohibiting elective procedures)

 

 

In consultation with the CCA’s attorneys, lobbyists, and other professional medical associations, multiple statements were released to our members from the CCA have and have been consistent regarding Executive Order 2020 009:

 

·       March 20, 2020: “postpone performing elective massage therapy at the present time.”

·       March 23, 2020: “…Nonessential visits from patients should very clearly be postponed, and group visits are ill-advised…”

·       March 26, 2020: “For patient care that is non-essential, meaning it can be delayed or reduced without an anticipated decline in patient health, such a delay or reduction should be considered.”

·       March 27, 2020: (In reference to DORA’s statement released on March 27th) “If the practitioner believes that one or another patient meets the narrow categories listed here, then the order and Division of Professions and Occupation’s (DPO) guidance allow for the discretion of the provider to provide a chiropractic procedure in those circumstances.”

 

Per Executive Order 2020 009, all chiropractic practices must postpone/ reschedule performance of elective care including, but not limited to, asymptomatic care, preventative care, non-medically necessary care or ancillary in-office services (such as non-therapeutic massage or other services).

Acute or emergency care, that falls under the guidance of Executive Order 2020 009 can be administered and should be done in accordance with other current executive orders issued by Governor Polis, local county orders and CDC guidelines.

Again, DORA’s notice on March 27, 2020 references Executive Order 2020 009:  

“No chiropractic procedure should be performed unless:

 

·      There is a threat to the patient’s life if the procedure is not performed;

·      There is a threat of permanent dysfunction of an extremity or organ system if the procedure is not performed;

·      There is a risk of metastasis or progression of staging of a disease or condition if the surgery is not performed; or

·      There is a risk that the patient’s condition will rapidly deteriorate if the procedure is not performed and there is a threat to life, or to an extremity or organ system, or of permanent dysfunction or disability.”


[…] If the practitioner believes that one or another patient meets the narrow categories listed here, then the order and Division of Professions and Occupation’s (DPO) guidance allow for the discretion of the provider to provide a chiropractic procedure in those circumstances.”

 

Each office choosing to still see acute or emergency patients must put in place a system for patients that may need “acute or emergency” treatment including but not limited to, a method to contact the chiropractor over the phone to determine if an in-patient procedure is necessary, pre-screening patients, maintaining social distancing and CDC prevention and safety precautions.

While it is understood that wellness care can aid in optimal health and function of the patient, to avoid potential exposure and community threat, we urge each chiropractor to consider the potential risks to public health.

We will continue to catalog more resources and updates on our website here: https://www.coloradochiropractic.org/news/493743/Evolving-Article-CORONAVIRUS-COVID-19-IN-THE-CHIROPRACTIC-OFFICE.htm.

 

Disclaimer - The Colorado Chiropractic Association is a professional association advocating for the rights of chiropractors and their patients across the state of Colorado. We are NOT a state agency or regulatory body. We are merely informing our membership regarding our understanding of what they are allowed to do during this difficult and confusing time. We are neither requiring nor recommending to you to keep your doors open nor requiring nor recommending to you to close your office at this time as we as an association cannot make this decision for you.  Should you have additional questions or concerns, we encourage you to seek independent legal advice.



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UPDATE FROM DORA DATES 3.27.2020 AT 9:20AM [UPDATED 3/27/2020 2:55PM]

Regarding the order sent out this morning from the Department of Regulatory Agencies – this order reiterates our messaging yesterday. The Executive Order 009 issued by the Governor’s office “applies to all chiropractic practices and it prohibits any elective procedures”.

 

“No chiropractic procedure should be performed unless:

 

·      There is a threat to the patient’s life if the procedure is not performed;

·      There is a threat of permanent dysfunction of an extremity or organ system if the procedure is not performed;

·      There is a risk of metastasis or progression of staging of a disease or condition if the surgery is not performed; or

·      There is a risk that the patient’s condition will rapidly deteriorate if the procedure is not performed and there is a threat to life, or to an extremity or organ system, or of permanent dysfunction or disability.”

 

As the CCA has previously stated and again reiterated by DORA, unless your patient falls into the categories above, you are “advised to suspend all non-essential healthcare practices at this time”.

 

DORA’s notices further states:

 

“If the practitioner believes that one or another patient meets the narrow categories listed here, then the order and Division of Professions and Occupation’s (DPO) guidance allow for the discretion of the provider to provide a chiropractic procedure in those circumstances.”

 

Be sure to check with your malpractice insurance regarding DORA’s latest notice on coverage for your practice.

 

We understand the Dentists received their own language from the Department of Regulatory Agencies today. Read that language here.

See all updates to the licensees and consumers here.

 

Disclaimer - The Colorado Chiropractic Association is a professional association advocating for the rights of chiropractors and their patients across the state of Colorado. We are NOT a state agency or regulatory body. We are merely informing our membership regarding our understanding of what they are allowed to do during this difficult and confusing time. We are neither requiring nor recommending to you to keep your doors open nor requiring nor recommending to you to close your office at this time as we as an association cannot make this decision for you.  Should you have additional questions or concerns, we encourage you to seek independent legal advice

 

Statement directly below from DORA:


Having trouble viewing this email?View it as a Web page.

CO DORA DPO Color Logo Lock Up

Prohibition on Chiropractic Elective Procedures

Dear Chiropractor Licensee,

The Division of Professions and Occupations (DPO) under the Department of Regulatory Agencies (DORA) has received a number of inquiries concerning the application ofExecutive Order D 2020 009. This email confirms that the Governor’s executive order applies to all chiropractic practices and it prohibits any elective procedure, including any chiropractic procedure, that does not fit within the very narrow categories listed in the order.

In particular, under Executive Order D 2020 009, no chiropractic procedure should be performed unless:

  • There is a threat to the patient’s life if the procedure is not performed;
  • There is a threat of permanent dysfunction of an extremity or organ system if the procedure is not performed;
  • There is a risk of metastasis or progression of staging of a disease or condition if the surgery is not performed; or
  • There is a risk that the patient's condition will rapidly deteriorate if the procedure is not performed and there is a threat to life, or to an extremity or organ system, or of permanent dysfunction or disability.

As is apparent, there are very few, if any, chiropractic procedures that fit within the rubric of these criteria. And as a result, we expect that most chiropractic practices across the state will necessarily halt operations during the emergency. Of course, if a practitioner believes that one or another patient meets the narrow categories listed here, then the order and DPO’s guidance allow for the discretion of the provider to provide a chiropractic procedure in those circumstances.

In summary, we advise you to suspendallnon-essential healthcare practices at this time. We understand that this may cause unfortunate financial difficulties, but it is imperative that we all do our part to stop the spread of COVID-19.

 

Do not reply to this email - this is not a monitored inbox.

CO DORA DPO White Logo Lock Up

 

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UPDATE ON GOV POLIS STAY-AT-HOME ORDER [UPDATED 3/26/2020 8:00PM]

The Colorado Chiropractic Association is continuing to help our members understand and address the COVID-19 pandemic and remain responsive to updates and changes as this situation continues to unfold.  It is our duty as an association to serve you our members, just as it is your duty to serve your patients and community.  As we continue to get questions from members or requests for additional information from the State, State regulatory agencies, counties and other local jurisdictions, we will continue to evaluate the current status and update you as appropriate.

 

Governor Polis has now issued a stay at home order for the state of Colorado. In addition, many counties and public health authorities have also issued their own stay at home orders. Each order is slightly different, but overall the same concept is there – prevent the spread of COVID-19 by limiting what can and cannot be done at this time, including by those in the health care professions.

 

This stay at home order is also subsequent to Executive Orders (EO) as published by the Governor relating to COVID-19, commencing with EO D 2020 003 Declaring a State of Emergency in Colorado due to the presence of COVID19, and subsequent orders addressing in-person gatherings (005), school attendance (007), suspension of elective medical procedures (009) and a fifty percent reduction in present work-forces in places of business (013), with these EO’s published from March 11th – March 22nd with ongoing enactment.

 

Under Colorado law, chiropractic care is an essential health benefit, and “Health Care Operations” are included as “critical” or “essential” business under the public health orders.  While the State and counties are exempting certain healthcare operations in their orders, certain healthcare providers have been prohibited from seeing patients in certain circumstances and other healthcare providers have been limited to seeing patients for only “essential” procedures. 

Recognizing that the various public health orders can all be read to include chiropractic care in the “critical” or “essential” business category of Health Care Operations, inclusion does not mean business as usual.  Governor Polis’ stay at home order requires critical businesses:

 

to comply with the guidance and directives for maintaining a clean and safe work environment issued by the Colorado Department of Public Health and Environment (CDPHE) and any applicable local health department.  Critical Businesses must comply with Social Distancing Requirements and all public health orders currently in effect to the greatest extent possible.

     

The CCA is not recommending to any of our members that they should either close or stay open.  For those that do decide to stay open, at a minimum, chiropractors should:

·       Comply with all public health orders, social distancing requirements, and CDC recommendations.

·       Continue with patient risk assessment to identify the optimal method of care delivery and prioritize a transition to telehealth services where able.

·       For patient care that is non-essential, meaning it can be delayed or reduced without an anticipated decline in patient health, such a delay or reduction should be considered.


·       For acute patient care, or care which may adversely affect the patient's health if it is postponed, such acute care should be addressed on a case by case basis, and if undertaken must be done in accordance with current public health orders and CDC guidelines.

 

This pandemic has a clear impact on your practices, staff, and families The CCA is actively working to find and encourage resources for impacted chiropractic practices. Federal efforts can be supported here.  As more resources are released in the coming days and weeks, they will be cataloged here: https://www.coloradochiropractic.org/news/493743/Evolving-Article-CORONAVIRUS-COVID-19-IN-THE-CHIROPRACTIC-OFFICE.htm.

 

Stay healthy, remain vigilant, and thank you for your continued support!

Disclaimer - The Colorado Chiropractic Association is a professional association advocating for the rights of chiropractors and their patients across the state of Colorado. We are NOT a state agency or regulatory body. We are merely informing our membership regarding our understanding of what they are allowed to do during this difficult and confusing time. We are neither requiring nor recommending to you to keep your doors open nor requiring nor recommending to you to close your office at this time as we as an association cannot make this decision for you.  Should you have additional questions or concerns, we encourage you to seek independent legal advice

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GOV. POLIS STAY-AT-HOME ORDER TO START ON 3/26/2020 [UPDATED 3/25/2020 9:00PM]
Here is the direct link to the statement: https://www.colorado.gov/governor/news/gov-polis-announces-statewide-stay-home-order-provides-update-colorado-response-covid-19

Here is a direct link to the physical order: https://www.colorado.gov/governor/news/gov-polis-announces-statewide-stay-home-order-provides-update-colorado-response-covid-19

Here is a direct link to the FAQ section issued by the Colorado Department of Public Health & Environment (CDPHE): https://drive.google.com/file/d/16nO05S6q0AGBew32r0NYelifwk11uDMO/view

Public Health order here: https://drive.google.com/file/d/1IzfYUaxEf-UFSVAzkY_b9Cf1OMPOdlxH/view

We are continuing to work with our team to provide information to the profession in this time.

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GOV. POLIS ISSUES STAY AT HOME ORDER TO START ON 3/26/2020 AT 8:00AM  [UPDATED 03/25/2020 4:30PM]

Dear Colorado Chiropractors -

I assure you that the CCA has been working diligently to monitor COVID-19 in the state of Colorado with our staff, Board, multiple attorneys and lobbying team to provide information for our members.

Gov. Jared Polis issued a statewide stay-at-home order Wednesday afternoon. This goes into effect starting Thursday March 26, 2020. 

The physical order issued today is set to be posted by midnight tonight. The CCA will continue to work with the Board, attorneys and lobbying team to analyze the statewide stay-at-home order once released. We will send further communication once we know more.

As we are receiving a high amount of phone calls at this time, we encourage everyone to continue to check our website first for further announcements. 

Stay healthy, remain vigilant! Thank you for your patience and continued support! 

Rachel Wendt, DC
CCA Executive Director

_________________________________________________________________



REGARDING LATEST NOTICE FROM DORA ON 3/24/2020 [UPDATED 3/24/2020 6:45 PM]

This notice has been sent to our attorney and lobbyist for review. Please stay tuned. We will send out more information as soon as we know more. We're doing everything we can to get the information to you as quickly as possible.

Original notice from DORA listed at the bottom of this page.

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DENVER STAY AT HOME ORDER ISSUED BY MAYOR HANCOCK [UPDATED 03/23/2020 6:00PM]

COVID-19 clearly presents challenges to our entire medical, business, and personal ecosystems in ways that we have never before seen. Information and recommendations are literally changing hourly, and vary vastly still from state to state and city to city and county to county.  

 

On March 23, 2020, Mayor Michael Hancock of Denver issued a “Stay at home” order effective March 24, 2020 starting at 5:00pm that will run through April 10, 2020 at 5:00pm. The order requires all individuals anywhere in the City and County of Denver to “shelter in place – that is, stay at home. […] All persons may leave their residences only for Essential Actives, Essential Governmental Functions, or to operate Essential Businesses.[…] Essential healthcare operations include “Hospitals, clinics and walk-in facilities…This exemption shall be construed broadly to avoid any impacts to the delivery of healthcare, broadly defined.”. You can read the full order here.

 

We have reviewed the text and concluded that chiropractic clinics are exempted for the delivery of healthcare. Therefore, chiropractic clinics can treat patients and patients can visit your clinic if the chiropractic clinic chooses to remain open.

 

The CCA understands the above applies to the City and County of Denver at this time and encourages all chiropractors to keep an eye on their local government agency for any updates or changes.

 

We do understand similar orders have been issued for the counties of San Miguel, Gunnison, Summit and Eagle. Links to the orders can be found by clicking on the individual county below:

UPDATED 3/23/2020 - 7:30PM

UPDATED 3/24/2020 - 6:00 PM

UPDATED 3/24/2020 - 3:00 PM

 

For a list of all counties with stay at home orders, click here: https://kdvr.com/news/coronavirus/list-all-of-the-colorado-counties-with-stay-at-home-orders/

 

There are 64 counties in Colorado. County Commissioners are responsible for each county. We will continue to update this list as information becomes available. 

 

The CCA encourages all chiropractors to stay up-to-date with recommendations and protocols established by the World Health Organization (WHO), the U.S. Centers of Disease Control and Prevention (CDC), local health departments, and the Colorado Chiropractic Board of Examiners rules, regulations, and policies in regard to COVID-19.  Additionally, the CCA encourages chiropractors and patients to follow any specific public health and safety directions from state and federal leaders. 

 

In light of this, we look for common, practical steps we can all take to mitigate the damage to our population. Here are our current recommendations for chiropractors, knowing some of these may change in the days to come.  

TO STAY OPEN OR TO CLOSE:

Please follow the your state, local and federal health authorities in this regard.

 

Disclaimer - The Colorado Chiropractic Association is a professional association advocating for the rights of chiropractors and their patients across the state of Colorado. We are NOT a state agency or regulatory body. We are merely informing our membership regarding what they are allowed to do during this difficult and confusing time. We are neither requiring or recommending you to keep your doors open nor requiring or recommending you to close your office at this time as we as an association cannot make this decision for you. Only the government, either state or federally, can make a mandate. When and/or if there is a mandate by either the state or federal government, we will inform our members and continue to disseminate information to Colorado doctors as it becomes available.

-Colorado Department of Public Health & Environment:

https://www.colorado.gov/cdphe

 

-CDC link:
https://www.cdc.gov/coronavirus/2019-ncov/index.html
 
-Directory of Local Health Departments
https://www.naccho.org/membership/lhd-directory
 
 
Generally speaking, if you choose not to close:

  1. Non-essential visits from patients should very clearly be postponed, and group visits are ill-advised. The primary means of transmission of the coronaviruses is through close personal contact, especially among groups and in spaces that cannot be adequately cleaned and monitored. The more people that pass through your offices, the greater the chances that one will have coronavirus or have come in contact with someone who has coronavirus.
  2. ALL patients should be prescreened by phone, before they come to their appointments, for any signs of illness, and for travel or exposure risks as outlined by public health authorities. No patient should arrive at your clinic ill. If a patient is ill on prescreening, they should remain home or be sent to the hospital if illness is severe. 
  3. Counsel patients by phone regarding health maintenance, sick care, and what to do if they’re feeling they have symptoms of coronavirus. 
  4. Encourage respiratory etiquette – including covering coughs and sneezes. Provide customers and the public with tissues and trash receptacles.
  5. Avoid having patients congregate in the waiting areas. Patients should be taken directly from the entryway to their treatment rooms if at all possible. Ensure social distancing recommendation of 6 (SIX) feet between people is applied to people who are in waiting areas. Many are using “mobile check-in” where the patient will call the office to check-in upon arrival, wait in their car and the office will call them when the doctor is ready to see the patient. 
  6. Stagger appointments so that patients do not overlap and wipe down any surfaces that may have been contacted during the visit with appropriate cleaning products. High volume clinics should decrease their volume if they cannot assure patient separation.
  7. Remove non-essential items that could be vectors for virus transmission from the waiting room, treatment rooms, and other common areas. These are items such as magazines, extra pens, papers, in the waiting area etc. Decreasing the number of points of contact for contaminants will decrease the risk of transmission and make cleaning procedures more effective.
  8. Gov. Polis issued Executive Order D2020 013 on March 22, 2020 –This order requires employers to cut 50% of their in-person workforce. Strategies to execute this order include scheduling your staff in shifts, if you can. All staff must remain 6 (SIX) feet apart when they are working under the same office.
  9. All non-essential services in your office should be halted for the time being.
  10. Per our previous recommendation, the CCA recommends halting all elective massage therapy in your office for the time being. Massage therapists in your office may continue to work if the treatment is part of an active treatment plan as determined by a licensed doctor or for medical treatment as determined by a licensed doctor, however the ultimate decision should be discussed with your current massage therapist.
  11. Maintain regular housekeeping practice, including routine cleaning and disinfecting of surfaces, equipment and other elements of the office. Discourage employees from sharing computers and phones if at all possible.
  12. Promote frequent hand washing for at least 20 seconds by employees and patients.
  13. Detailed guidance on workplace preparedness can also be found from OSHA: https://www.osha.gov/Publications/OSHA3990.pdf

 
IN ALL CIRCUMSTANCES, OBSERVE THE BASICS!

● Avoid close contact with people who are sick. 
● Avoid touching your eyes, nose, and mouth with unwashed hands. 
● Wash your hands often with soap and water for at least 20 seconds. Use an alcohol-based hand sanitizer that contains 60%-90% alcohol if soap and water are not available. COVID-19 can transmit through both respiratory droplets and via stool, so careful handwashing is critical. 
● Cover coughs and sneezes with a tissue, then throw it in the trash can. Cough or sneeze into your elbow and not your hand if you do not have a tissue available. If you contaminate your hand and then touch other objects, you will spread the virus. Wash your hands for at least 20 seconds if you cough.


INFORMATION ON INCUBATION FROM PUBMED*

“The median incubation period was estimated to be 5.1 days, and 97.5% of those who develop symptoms will do so within 11.5 days (CI, 8.2 to 15.6 days) of infection. These estimates imply that, under conservative assumptions, 101 out of every 10 000 cases (99th percentile, 482) will develop symptoms after 14 days of active monitoring or quarantine.” Read more on this here

CALL YOUR SENATORS NOW TO ENSURE RELIEF FOR PROVIDERS, INCLUDING CHIROPRACTORS [UPDATED 3/23/2020 9:00AM]

Background: Senators Michael Bennet (D-Colo.) and John Barrasso (R-Wyo.) have introduced the Immediate Relief for Rural Facilities and Providers Act, new legislation to address the impending crisis facing our health care system as the spread of COVID-19 increasingly strains hospitals and providers across the country. Bennet and Barrasso’s new legislation would extend a lifeline to rural hospitals, and all providers and the millions of Americans who depend on them for health care.

Among help for rural hospitals, the Bennet/Barrasso legislation will:

  • Provide Stabilization and Relief for all Providers, including chiropractors with an emergency, one-time grant for all providers and ambulatory surgery centers equal to their total payroll from January 1 - April 1, 2019 
  • Provide Funding for all Physicians and Providers, including chiropractors by authorizing the Small Business Administration to provide low interest loans to providers and ambulatory surgery centers at a 0.25% interest rate that will not accrue until two years after the COVID-19 pandemic has ended.

What you need to do:  Call the senate switchboard at 202-224-3121 or find your state senators’ office here and ask them “to include the Immediate Relief for Rural Facilities and Providers Act, sponsored by senators Bennet and Barrasso, in the current Senate COVID-19 relief package.”

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RESOURCES FOR DOCTORS [UPDATED 03/20/2020 7:00PM]
COVID19 & HIPAA NOTICE FROM CMS
ChiroArmor Phone Screening for COVID-19
ChiroArmor "What to know about COVID-19"
ChiroArmor Cleaning Procedure Info Form
ChiroArmor Hand Washing Procedure Form

DORA COVID-19 UPDATES FOR LICENSEES AND CONSUMERS [UPDATED 03/20/2020 6:15PM]

CLICK HERE (link below) for the latest updates for licensees in Colorado:
https://www.colorado.gov/pacific/dora/covid-19-updates-licensees-and-consumers?utm_medium=email&utm_source=govdelivery

MASSAGE THERAPISTS IN THE CHIROPRACTIC OFFICE [UPDATED 3/20/2020 6:15PM]
The public health crisis has generated more questions than answer for medical professionals in Colorado and throughout our nation.  The CCA is doing all we can to stay on top of this rapidly moving pandemic and is striving to keep you informed.

On March 19, 2020, Colorado Governor Polis ordered the Temporary Cessation of All Elective and Non-Essential Surgeries and Procedures and Preserving Personal Protective Equipment and Ventilators in ColoradoRead the full order here.

 

Since Governor Polis’ press release was announced, the CCA reached out to other health care organizations, various state and local agencies, including the Department of Regulatory Agencies (DORA) to share and gather information.  At this time, the CCA recommends that all chiropractic practices who have massage therapy in their office to postpone performing elective massage therapy at the present time.

 

The Colorado Chiropractic Association is in agreement with the Federation of Chiropractic Licensing Boards in affirming doctors of chiropractic are essential health care providers, ready to serve their communities both in daily care and in times of urgent need. Chiropractors, other health care practitioners, and staff are a part of the health care community and have a responsibility for the prevention and mitigation efforts during this pandemic while managing the urgent needs of patients during this crisis. Everyone is at risk for the transmission and contraction of COVID-19. Our top priority must be the health of the public and your patients.

 

The COVID-19 pandemic is a public health emergency and chiropractors have an important role to play. In light of what many expect will be heavy burdens on other segments of the health care system, chiropractors have a special duty to continue to provide the care that patients need, and cannot receive elsewhere. Chiropractors have the ability to prevent patients from treating themselves, self-diagnosing and seeking emergency facilities.

 

The CCA encourages all chiropractors to stay up-to-date with recommendations and protocols established by the World Health Organization (WHO), the U.S. Centers of Disease Control and Prevention (CDC), local health departments, and the Colorado Chiropractic Board of Examiners rules, regulations, and policies in regard to COVID-19.  Additionally, the CCA encourages chiropractors and patients to follow any specific public health and safety directions from state and federal leaders. 

 

The CCA is providing this for informational purposes only. We do NOT have any knowledge of pending or future governmental action that may hypothetically require offices to close. The CCA continues to communicate with state agencies and other officials and the CCA will continue to disseminate information to its members as soon as possible.

 

RESOURCES FOR TELEHEALTH [UPDATED 3/20/2020 5:00PM]

Courtesy of David Klein here is an update: All, Hopefully this article will prove helpful regarding TELEHEALTH and home care https://paydc.com/2020/03/19/telehealth-and-home-care-for-chiropractic-and-physical-medicine-practices/?fbclid=IwAR00PLdPwXrrJasQ9VcKruaxQ3O8jGG9czR0PrbgX0iPbF02bZH6bT5O_8g

 

Zoom has HIPAA compliant software. To learn more, visit https://zoom.us/healthcare

 

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FAKE ONLINE CORONAVIRUS MAP DELIVERS WELL-KNOWN MALWARE  [UPDATED 3/19/2020 12:00PM] 

The U.S. Dept. of Health & Human Services and the U.S. Health Sector Cybersecurity Coordination Center have posted a notice about a malicious website related to the coronavirus.  The website pretending to be the live map for Coronavirus COVID-19 Global Cases by Johns Hopkins University is circulating on the internet waiting for unwitting internet users to visit the website. Visiting the website infects the user with the AZORult trojan, an information stealing program which can exfiltrate a variety of sensitive data. It is likely being spread via infected email attachments, malicious online advertisements, and social engineering. Furthermore, anyone searching the internet for a Coronavirus map could unwittingly navigate to this malicious website. 


We are advised that end users should be warned about this cybersecurity risk and security teams should blacklist any indicators associated with this specific threat. Read the actual notice here.

 

COLORADO HEALTH OFFICIALS BAN PUBLIC GATHERINGS OF MORE THAN 10 PEOPEL WITH SEVERAL EXCEPTIONS [UPDATE 3/19/2020 9:45AM]

The Colorado Department of Public Health and Environment announced Wednesday a statewide ban on public gatherings of more than 10 people. There are several exceptions to the order.

The order goes into effect 12:01 a.m. Thursday. It is set to last for 30 days.

Health officials are implementing the ban in an effort to slow the spread of the coronavirus.

There will be exemptions for grocery and retail stores, airports, bus and train stations, health care facilities, pharmacies and other places where people may be in transit for essential goods and services.

Restaurants following the already-imposed takeout and delivery guidelines will also be exempt.

Office environments, government buildings where essential government services are offered, and factories where at least 10 people are present but social distancing of 6 feet is in effect will also all be exempt.  

“We are acting boldly and swiftly together to protect the health and safety of all Coloradans. The science and data tells us this will get worse before it gets better,” Polis said in a statement. “We are in this together and the state is taking the necessary actions to slow the spread of this disease.”

The governor also suspended in-person learning at all schools from March 23 through April 17.

Finally, the governor suspended all downhill ski area operations through April 6.

_________________________________________________________________

 

IMPACT OF CORONAVIRUS ON THE LEGISLATIVE SESSION FROM CCA'S LOBBYING TEAM [UPDATED 3/18/2020 6:00PM]

On Tuesday March 10th Gov. Polis declared a state of emergency in Colorado over the Coronavirus outbreak. On Friday the Governor urged Coloradans to avoid gatherings exceeding 250 people. Schools, sporting events, concerts and other public events have all been effected.  

 
The Executive Committee of the Colorado Legislature met this afternoon at 4pm. They have prepared two bipartisan resolutions, one to recess starting Saturday March 14 through March 30 at 10:00 am. The other requesting legal guidance from the Colorado Supreme Court whether the constitutional requirement that the legislature only meet for 120 days in general session needs to be consecutive days or not.

During the two week recess, House and Senate staff will be doing an assessment of legislative work that has to be completed before they adjourn sine die. This will allow House and Senate leadership to have a list of outstanding items to consider when they come back into session.

Legislative Leadership has also waived all of the deadlines for the introduction and passage of the budget and the School Finance Act. Taking a two week recess will allow the JBC and their staff to really take time to assess the impact on the budget and the revenue forecast. To that end the Joint Budget Committee will still be hearing the March revenue forecast on Monday March 16th, as well as finishing figure setting and comebacks by EOD Wednesday March 18th. 

 

We will continue to monitor the situation and will inform you of any changes as we hear them.  Please feel free to let us know if you have any questions.

_________________________________________________________________

 

CCA OFFICE [UPDATED 3/17/2020 5:30PM]
The CCA office remains open, although some of our staff will be working remotely. We are committed to assisting our members and serving your needs. If you have a question, please call the office at 303-755-9011 or send us an email at CCA@ColoradoChiropractic.org. We urge you to keep checking the “Latest New” post on our homepage for the latest updates on COVID-19 as it relates to the state of Colorado.

IMPACT OF CORONAVIRUS ON SCHEDULED CCA EVENT PROGRAMS [UPDATED 3/17/2020 5:30PM]
President Trump recently announced coronavirus guidelines, recommending that all Americans avoid group gatherings of more than 10 people. CCA continues to monitor the rapidly changing situation related to the spread of COVID-19. We understand that concerns for health, safety, and the impact on meeting attendance, among other issues, are affecting our members.

The CCA is looking at hosting the April 11, 2020 PPE remotely and will have registration open for that specific event shortly. We are continuing to monitor the state of Colorado and will post updates to each event as we move forward. 

HIPAA REMINDER - COVID-19 FROM NCMIC [UPDATED 3/17/2020 10:00AM] 

Original article here from NCMIC

While social media is blowing up with so called “facts” about the Coronavirus, something that every clinician needs to remember is that following HIPAA  guidelines is paramount.

As an example, when an Ohio case was announced yesterday, I received a call from a friend telling me that the man testing positive lives about three miles from a family member.  Unless that individual or his family member shared that information, this type of information should not be out in “air waves”. Let’s be clear, the 18 Protected Health Information (PHI) identifiers include:

•             Names

•             Dates, except year

•             Telephone numbers

•             Geographic data

•             FAX numbers

•             Social Security numbers

•             Email addresses

•             Medical record numbers

•             Account numbers

•             Health plan beneficiary numbers

•             Certificate/license numbers

•             Vehicle identifiers and serial numbers including license plates

•             Web URLs

•             Device identifiers and serial numbers

•             Internet protocol addresses

•             Full face photos and comparable images

•             Biometric identifiers (i.e. retinal scan, fingerprints)

•             Any unique identifying number or code

HIPAA has a special guidance section for what information and to whom that information can be released during an emergency situation. You can review these guidelines at: https://www.hhs.gov/hipaa/for-professionals/special-topics/emergency-preparedness/decision-tool-overview/index.html  

Office of Civil Rights

Always remember the Office of Civil Rights (OCR) is very clear in their message:  there needs to be a balance between protecting the privacy of patient PHI (protected health information) and the appropriate use and disclosure of information to protect the public.

 

X-RAY REGULATORY REQUIREMENTS DURING COVID-19 [UPDATED 3/17/2020 5:15PM]

COVID-19 Extensions for Certification Evaluation of Radiation Machines and Facilities Subject to 6 CCR 1007-1 Part 02 and 06

In the interest of preventing transmission of COVID-19 the Colorado Department of Public Health and Environment is exercising regulatory flexibility and providing an extension to the requirements for select radiation machine and facility certification evaluations. 

For those radiation machines and facilities that require an initial certification evaluation within 90 days of use as per Section 6.6.1.2 the department is providing an additional 90 days for the completion of the initial evaluation.  Please note, the requirements of 2.5.1.5 and 2.5.1.6 still remain in force and an evaluation of those machines prior to being used to perform any human examination is still required.

Radiation machines and facilities that are due for a certification evaluation, as per Section 2.5 of the Regulations, during the months of March, April, May and June of 2020 shall be granted a 6 month extension to complete that evaluation.

Please feel free to contact the X-ray Certification Unit with any questions at 303-692-3448 
or via email at cdphe.hmxraycomments@state.co.us.  

 

This information is also posted on the website at: https://www.colorado.gov/pacific/cdphe/xray

ADVERTISING [UPDATED 3/17/2020 11:30AM]

Note also, the CCA strongly recommends that our members exercise extreme care in advertising at this time and refrain from making claims that are not substantiated by peer-reviewed, empirical evidence.  Regulators are on high alert for the exploitation of the pandemic and may view as grounds for license suspension any claim that certain treatments can prevent or cure COVID-19 until more is known about the virus. We do understand the federal government, including the FTC and FDA are on high alert at this time.

While we understand that each business has the right to make their own decisions when it comes to advertising, we would like to highlight Rule 1.12 from the Department of Regulatory Agencies for those docs who may not be familiar. Find the full list of Statute, Rules and Policies here.

1.12 Misleading, Deceptive, False, or Unethical Advertising

A. Chiropractors are responsible for the content of their advertising.

B. The following types of advertising constitute misleading, deceptive, false, or unethical advertising pursuant to sections 12-215-115(1)(h), (o) and (5):

1. The misleading use of a claim regarding board certification or of an unearned or nonhealth degree in any advertisement or any claim that is likely to cause confusion or misunderstanding as to the credentials, education, or licensure of a healthcare professional;

2. Advertising that has the effect of intimidating or exerting undue pressure;

3. Advertising that uses unsubstantiated testimonials;

4. Advertising that creates an unjustified expectation or guarantees a cure;

5. Advertising that offers gratuitous services or discounts in a manner that is deceiving to the public;

6. Advertising of free or discounted x-ray services; or

7. Advertising that is otherwise misleading, deceptive, or false.

8. It must be clear to the public that the advertisement is from a doctor of chiropractic.

C. At the time any type of advertisement is placed, the chiropractor must possess, scientifically valid research that would substantiate the truthfulness of any assertion, omission, or claim set forth in the advertisement. Scientifically valid research includes applied research, basic research, and field-initiated research in which the rationale, design, and interpretation are soundly developed in accordance with principles of scientific research.

 

_________________________________________________________________

QUESTIONS FROM MEMBERS [UPDATED 3/16/2020 10:30AM]

The following are the most common questions we are receiving in the CCA office at this time:

  • “Essential services”:  whether services of chiropractors are deemed to be “essential services” that may remain open in the event that the government declares that all businesses close:  At this time, we do not know which governmental branch may make such a declaration or what the guidelines will be.  If and when a “close order” happens, we will carefully review and update this information.
  • Closing of offices:  at this time, the CCA recommends that doctors use their best professional judgment, applying relevant guidelines, such as those of the CDC and the White House Coronavirus Task Force, to determine whether to close offices. 
  • Offices remaining open:  for offices that remain open, the CCA recommends:

· Apply all CDC guidelines regarding the screening of patients who call with concerns that they may be infected with Coronavirus (see link below) and refer the patient to their county health department;

· Reschedule staff and patients so that no more than 10 persons are in the office at a time;

· Conduct “pre-screening” of staff at the beginning of the shift and prior to any patient contact, using CDC guidelines for assessing the presence of symptoms and risk, and sending staff home or referring for testing where appropriate.  The CDPHE recommends these steps for nursing facilities, and the CCA believes this is a prudent practice in physician offices;

· Apply all CDC guidance and standard of care regarding infection prevention (see links below), including using disposable surgical gloves for each patient and regular disinfection of patient surfaces and facilities;

· Suspend restrictions on cancellations and do not apply penalties for cancellations and no-shows;

· Begin to plan for the possibility of remote employment; i.e., consider whether some of your staff, such as billers, could work from home.

· There is no general order or algorithm to determine whether health care offices should close at this time.  However, the CCA recommends closing any office that does not have staff or resources to maintain strict CDC disinfecting protocols, social distancing, and other prevention tools. Chiropractors may want to review their release to assist in deciding whether to remain open or temporarily close. It is ultimately your business decision to close. We will continue to monitor updates from Gov. Polis as it relates to the closure of business.

  • Cancellation of events:  based on the White House Coronavirus Task Force guideline to cancel events with more than 10 people, the CCA strongly suggests chiropractic offices should cancel all such events, such as health fairs or informational seminars, for the foreseeable future.
  • Home office visits: The CCA recommends first, you should check your insurance contract to see if this is covered outside the physical chiropractic office. Second, you should check with your malpractice insurance to see if a visit is covered at a remote office. Third, you should be cautious on the patient's symptoms and all persons in the home prior to entry as well as practice and follow all CDC guidelines on proper protocol as it relates to disinfecting and protecting all chiropractic equipment used.
  • Liability: Example: Am I liable if I come in contact with COVID-19, continue to treat patients asymptomatically, then unknowingly infect a patient with COVID-19? The CCA recommends practitioners should closely monitor and follow their State / County / City / Legislative and Regulatory (DORA) recommendations and directives. NCMIC like most agencies has an exclusion for communicable diseases.  In other words, if someone sues you for giving them ANY communicable disease, there is no coverage under your malpractice policy. Please check you malpractice coverage.


MARCH 16, 2020 [UPDATED 3/16/2020 10:00AM]

Colorado Gov. Jared Polis declared a state of emergency on March 10 in response to recent cases of COVID-19 in the state.

The new strain of coronavirus began popping up in the United States in February. On March 5, the first case was announced in Colorado. As of Tuesday morning, Polis said three new cases of COVID-19 have been confirmed in the state, bringing the total number to 15.

On March 15, 2020, the Colorado Department of Public Health and Environment (CDPHE) following Centers for Disease Control and Prevention (CDC) guidance, recommends that event organizers (groups or individuals) cancel or postpone in-person events that consist of 50 people or more. The CDPHE request can be found here.

 

CMS RELEASE FOR PROVIDERS [UPDATED 3/16/2020]

On March 12, 2020, the Centers for Medicare & Medicaid Services (CMS) posted Frequently Asked Questions (FAQs) to the Medicaid.gov website to aid state Medicaid and Children’s Health Insurance Program (CHIP) agencies in their response to the 2019 Novel Coronavirus (COVID-19) outbreak. CMS is taking this action in its continuing efforts to protect the health and safety of providers and patients, including those who are covered by Medicaid and CHIP.

A press release with further information can be found here: https://www.cms.gov/newsroom/press-releases/cms-publishes-first-set-covid-19-frequently-asked-questions-faqs-state-medicaid-and-childrens-health

The COVID-19 FAQs for State Medicaid and CHIP agencies can be found here: https://www.medicaid.gov/state-resource-center/disaster-response-toolkit/covid19/index.html

These FAQs, and earlier CMS actions in response to the COVID-19 virus, are part of the ongoing White House Task Force efforts. To keep up with the important work CMS is doing in response to COVID-19, please visit the Current Emergencies Website. 

 

The Center for Medicaid and Medicare Services (CMS) has issued a number of releases containing information for disease mitigation in specific settings. The following link is a good, detailed strategy for community mitigation based on the level of community transmission:  https://www.cdc.gov/coronavirus/2019-ncov/downloads/community-mitigation-strategy.pdf.

 

As the CCA will continue to monitor CDC and other resources, we again encourage members to regularly check CDC and CDPHE information in the links below, as they are revised to update the public, healthcare providers, and employers on this rapidly developing issue. 

_________________________________________________________________

TEMPLATE LETTER FOR PATIENTS [UPDATED 3/13/2020]

 

Also, the CCA is making available to our members a template letter for our doctors to send to their patients regarding the COVID-19 virus (coronavirus).  The letter explains the steps you are taking in your offices to protect your patients, as well as your recommendations for measures your patients should take outside of the office. The template will need to be tailored to reflect your individual office procedures and policies. The template letter can be found here.


On March 11, 2020, the World Health Organization declared COVID-19 a pandemic, the first to be caused by coronavirus.  The WHO director said hope remains that COVID-19 can be curtailed, and he urged countries to take action now to stop the disease.

The CCA has been carefully monitoring the CDC and other information on the COVID-19 (coronavirus 2019).  Although the CCA is not and cannot be a primary source on this subject, we want to make our members aware of relevant information that has been published by the CDC, the State of Colorado, and other reliable sources.  The spread of this virus has particular implications for chiropractic offices, as both health care providers and as employers. 

The COVID-19 outbreak is rapidly evolving, and information is constantly changing.  For that reason, the CCA strongly recommends that chiropractors stay up to date with guidance issued by the U.S. Centers for Disease Control and Prevention (CDC).  The CDC has provided a number of links (end of the article below) to general information about the virus, as well as information for healthcare professionals and businesses.  CDC updates these sites continually as information becomes available.   The Colorado Department of Public Health and Environment (CDPHE)) has also created a webpage (end of the article below) with coronavirus updates, including statistics on persons under investigation and positive cases in Colorado.  The CDPHE page contains links to other recommendations, such as ways to reduce community spread and guidance for businesses, travel, and households.

CDC INFORMATION FOR CLINICIANS [UPDATED 3/13/2020]

The CDC presented a one-hour live webinar for clinicians on March 5th. It is now available at no cost on-demand here.  The presenters reported on important updates, including recommendations for office protocols for control of the spread of the virus.  The experts recommend similar protocols for other infectious diseases, such as influenza. Aside from the obvious standards for the physical facility and staff (sanitizing surfaces, handwashing, etc.), if a patient presents to the office with symptoms, the patient should be separated from others in the waiting area and masked to prevent the spread of droplets.

 

The CDC also discussed how to determine which patients to refer for testing.  CDC recommends using professional judgment to assess the presence of the following factors in presenting patients:

  • Epidemiological factors such as being in close contact with a diagnosed patient or having been in an area of known community transmission
  • Symptoms including:
  • Fever
  • Acute respiratory illness – cough, shortness of breath, difficulty breathing
  • Myalgia
  • Fatigue
  • Persons over 65 years of age
  • Persons with underlying conditions and comorbidities

 

CDC INFORMATION FOR EMPLOYERS [UPDATED 3/13/2020]

The CDC recommends the following strategies for employers to use now.  The CCA has summarized the strategies here but strongly urges clinic owners to click on the link at the end of this article to review the details provided for businesses by the CDC:

  • Actively encourage sick employees to stay home;
  • Separate sick employees;
  • Emphasize staying home when sick, respiratory etiquette and hand hygiene by all employees;
  • Perform routine environmental cleaning:
  • Advise employees before traveling to take certain steps as outlined in the employer link below
  • Additional Measures in Response to Currently Occurring Sporadic Importations of the COVID-19:
  • Employees who are well but who have a sick family member at home with COVID-19 should notify their supervisor and refer to CDC guidance for how to conduct a risk assessment of their potential exposure.
  • If an employee is confirmed to have COVID-19, employers should inform fellow employees of their possible exposure to COVID-19 in the workplace but maintain confidentiality as required by the Americans with Disabilities Act (ADA). Employees exposed to a co-worker with confirmed COVID-19 should refer to CDC guidance for how to conduct a risk assessment of their potential exposure.

 

 

EXTERNAL LINKS

General Information on Coronavirus (COVID-19)

Healthcare Professionals

Businesses

Colorado Department of Public Heath & Environment Coronavirus Updates

NCMIC Resources

 

CO-HELP is Colorado’s call line for the novel coronavirus (COVID-19). People who have general questions about COVID-19 can call CO HELP at 303-389-1687 or 1-877-462-2911, for answers in many languages, or email them at COHELP@RMPDC.org for answers in English.

 

_________________________________________________________________

 

NOTICES FROM THE DEPARTMENT OF REGULATORY AGENCIES:

 

 

 

 

Friday, March 13, 2020

Dear Healthcare Professional:

The Division of Professions and Occupations has assembled theattached documentdetailing existing provisions and exemptions that can be used to bolster the healthcare workforce as part of the state’s ongoing efforts to combat the spread of Coronavirus.

This guidance will allow individuals in the healthcare field who hold licenses in other states, who have an inactive license, or who have allowed their license to expire in Colorado to immediately resume work within their scope of practice, provided their out-of-state, inactive or expired license is/was in good standing.

These measures will bolster the workforce’s ability to test, treat and care for patients amid this growing crisis by augmenting the number of qualified professionals while creating the ability to backfill positions, as necessary.

The temporary licensure provisions are part of an emergency directive from Gov. Jared Polis to provide support to a taxed healthcare system.

Healthcare providers who are being called upon to assist in caring for patients, but who are wondering if they can lawfully practice without a current Colorado license, should consider the attached exemptions before resuming work in the field, and should contact the Division with questions.

Please monitor your email for communications regarding any future regulatory measures aimed at combating the spread of COVID-19 in Colorado.

 

_________________________________________________________________


 

 

 

Friday, March 13, 2020

Dear Licensee,

The Division of Professions and Occupations (DPO) is actively assessing daily events related to the spread of COVID-19 in our state. The Division understands that many of our licensees are on the front lines of identifying, monitoring and caring for patients, or could come in contact with those who have become ill, and wants to ensure that each of you are equipped with the latest information to combat the spread of the virus while ensuring your safety on the job.

The Division currently is in the process of conducting assessments of its program areas and customer service functions to identify where additional resources may be needed or redirected. Potential action to address requests and concerns regarding Division and Board services are under review. Considerations include expedited licensure, telehealth policies and rules, ongoing and potential virtual public meetings and other external events. We appreciate your patience as these assessments continue, and will be sending updated communications if and when they are required.

In the meantime, we would like to stress the importance of continually checking for updates from theCenter for Disease Controland our stateDepartment of Public Health and Environment. CDPHE’s call line (303-389-1687 or 1-877-462-2911) is available with information in multiple languages.

CDPHE is providing ongoing information specific tohealthcare agencies and providers, and has set up a specific provider hotline (303-692-2700 weekdays from 8:30-5:00 pm and 303-370-9395 after hours and weekends). We encourage you to consult these and other resources, and to reach out with questions or concerns.

We truly appreciate all you are doing for Coloradans at this time, and will do all we can to ensure that you have the necessary tools and information to continue your work.

With regards,

 

Ronne Hines Director, Division of Professions and Occupations

 

_________________________________________________________________


 

 

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NEWS RELEASE

For Immediate Release: March 18, 2020

Media Contact

Jill Sarmo
P: 303-204-1766
Jillian.Sarmo@state.co.us
www.dora.colorado.gov

DORA releases emergency measures for healthcare professional licensing in response to COVID-19

 

DENVER -In response to the recent COVID-19 developments anddirectives given by Governor Polis, the Division of Professions and Occupations under the Department of Regulatory Agencies (DORA) will expedite licensing to increase workforce capacity to address this emergency. This includes the temporary suspension of the application of laws, rules and policies that will allow the State to expand its testing capacity for Coronavirus and ensure ongoing business continuity in the delivery of healthcare services.

“This virus will put a strain on our systems and healthcare worker heroes on the front lines of this battle. In order to quickly scale up our healthcare workforce capacity, I directed the Colorado Department of Regulatory Agencies to cut through the red tape on licensing our medical professionals so that medical professionals with licenses in other states can practice immediately in Colorado,”said Governor Polis.

“DORA divisions have been working diligently to address the many questions and concerns of Colorado professionals in the healthcare industry, and we are thrilled that so many people have already stepped up to answer Governor Polis’s call for assistance,”stated DORA Executive Director Patty Salazar.“Our divisions will continue to explore ways that we can do our part to address this crisis in the coming days and weeks, and we want both our licensees and Colorado consumers to know that we are here to help.”

The emergency measures include key provisions for renewal waivers, expedited licensure, waiver of supervision requirements, and expanded scope of practice for select health care providers such as physicians, physician assistants, nurses, pharmacists, pharmacy technicians, and respiratory therapists, including, but not limited to:

  • Waiving licensing requirements and rules to allow for late renewals as well as reinstatements and reactivations during the emergency period of volunteer nurses and qualified licensed providers from out of state;
  • Waiving limitations on clinical instruction via simulation;
  • Expanding scope of practice for physician assistants and nurses;
  • Expanding opportunities for telemedicine;
  • Allowing pharmacists to administer vaccines.

The full list of emergency measures can be viewedhere.

It is anticipated the suspension of these laws and rules, particularly as they apply to out-of-state practitioners, shall last until the expiration ofExecutive Order D 2020-003, or unless additional directives are received by the Governor.

For healthcare professionals seeking to get involved, Governor Polis has just announcedHelpColoradoNow.orgas a website for those Coloradans hoping to volunteer or assist in the COVID-19 response in a variety of ways.

###

The Department of Regulatory Agencies (DORA) is dedicated to preserving the integrity of the marketplace and is committed to promoting a fair and competitive business environment in Colorado. Consumer protection is our mission. Visitwww.dora.colorado.govfor more information or call 303-894-7855/toll free 1-800-886-7675.

 

 

_________________________________________________________________


 

 Colorado Department of Regulatory Agencies sent this bulletin at 03/23/2020 11:03 AM MDT

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Personal Protective Equipment Needed for COVID-19 Response

Dear Licensee:

The following is a communication that the Division of Professions and Occupations at DORA is distributing on behalf of Colorado Governor Jared Polis. Please note, DORA is not currently accepting or distributing these items, and all contributions as well as requests for PPE will need to adhere to the instructions outlined in the Governor's letter, below.

Thank you for all you are doing in our state's time of need.

Respectfully,

Ronne Hines

Director, Division of Professions and Occupations


ALetter to Colorado Healthcare and Health Services Professionals from Governor Jared Polis

As the State of Colorado comes together to respond to Conoravirus disease 2019 (COVID-19) we are faced with a shortage of Personal Protective Equipment (PPE) for our health care workforce. As you know from your own experience, without this protection, our health care workforce is unable to perform their critical duties and our health care system can not operate at the capacity we need in this crisis.

Today, I am reaching out to you because I need your help to save the lives of our fellow Coloradans. I am requesting that you review all of the PPE in stock in your offices.

Specifically, we are looking for information regarding the quantity of the following pieces of equipment:

  • Eye protection and goggles
  • Face shields
  • Surgical masks - with shields
  • Surgical masks - without shields
  • N95 masks
  • Non-sterile gloves
  • Sterile gloves
  • Disposable gowns
  • Biohazard bags
  • Anesthesia machines
  • Ventilators, whether in use for medical care, animal care, or research.

I am asking for you to keep the bare minimum amount of supply you need to conduct essential or life saving functions, and contribute the remainder to our state's COVID19 response.

If you have small quantities of supplies to contribute, between 1-25 boxes of personal protective equipment (i.e., six boxes of protective eye glasses) we ask that you donate these supplies to yourlocal public health department,local community health center, community clinic, or local hospital.

If you have more than 25 boxes, or the pieces of larger equipment such as anesthesia machines or ventilators, we ask that you fill outTHIS FORM, so we can determine if these items are needed in our state’s emergency supply. Once we receive your form entry, we will follow up with you to determine next steps.Please completeTHIS FORMby Friday, March 27 at noon.

Thank you in advance for your cooperation with this request. Working together, we can get through this crisis.

If you have questions about this request please reach emailPPE@state.co.us.

Sincerely,

Jared Polis

Governor


Find Your Local Public Health Department


Find Your Local Community Health Center


How to Request PPE

If you or your organization are experiencing a shortage or outage of personal protective equipment (masks, gloves, gowns, etc) to conduct essential or life saving functions during this crisis, please reach out to your local emergency manager or local public health department. These entities are connectedto the state's emergency operations center through their local/Tribal emergency operations center, and are the best contact for your request. Thank you for your work serving Coloradans during this difficult time.

 

Find Your Local Community Emergency Manager

 

 

_________________________________________________________________


 

 Colorado Department of Regulatory Agencies sent this bulletin at 03/24/2020 5:14 PM MDT

 

 

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FAQ for Healthcare Professionals Now Available

Dear Licensee:

The Novel Coronavirus (COVID-19) has impacted healthcare professionals across Colorado in unprecedented ways. For DORA, the pandemic has created myriad questions and scenarios to address on an ongoing basis, along with an increased need for timely, accurate information for our licensees.

We are listening and responding to the issues that have emerged within this rapidly changing landscape, in concert with the Governor’s Office and other state agencies. And we want to ensure that we continue to distribute information that provides clarity within this unpredictable environment.

To that end, DORA has created aCOVID-19 FAQ for Healthcare Professionalsto help distill, amplify and further define information provided over the last week.

We are cognizant that there are questions still unanswered, and are working to provide those in the future. Many of you have written to us with specific topics, which we continue to analyze and respond to in as timely a manner as possible. Please continue to check your email andDORA’s COVID-19 informational websitefor further updates as they become available.

We also want to express our gratitude to the many formerly licensed professionals or out-of-state licensees who, to date, have offered their services and healthcare knowledge for combatting the Coronavirus as volunteers. Those interested in signing up to volunteer can visithttps://cohealthvol.nationbuilder.com, where efforts to place workers with facilities in need will now be coordinated.

Thank you.

 

_________________________________________________________________

 

 

EMAIL FROM DORA 3/27/2020 9:20AM

 

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Prohibition on Chiropractic Elective Procedures

Dear Chiropractor Licensee,

The Division of Professions and Occupations (DPO) under the Department of Regulatory Agencies (DORA) has received a number of inquiries concerning the application ofExecutive Order D 2020 009. This email confirms that the Governor’s executive order applies to all chiropractic practices and it prohibits any elective procedure, including any chiropractic procedure, that does not fit within the very narrow categories listed in the order.

In particular, under Executive Order D 2020 009, no chiropractic procedure should be performed unless:

  • There is a threat to the patient’s life if the procedure is not performed;
  • There is a threat of permanent dysfunction of an extremity or organ system if the procedure is not performed;
  • There is a risk of metastasis or progression of staging of a disease or condition if the surgery is not performed; or
  • There is a risk that the patient's condition will rapidly deteriorate if the procedure is not performed and there is a threat to life, or to an extremity or organ system, or of permanent dysfunction or disability.

As is apparent, there are very few, if any, chiropractic procedures that fit within the rubric of these criteria. And as a result, we expect that most chiropractic practices across the state will necessarily halt operations during the emergency. Of course, if a practitioner believes that one or another patient meets the narrow categories listed here, then the order and DPO’s guidance allow for the discretion of the provider to provide a chiropractic procedure in those circumstances.

In summary, we advise you to suspendallnon-essential healthcare practices at this time. We understand that this may cause unfortunate financial difficulties, but it is imperative that we all do our part to stop the spread of COVID-19.

 

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_________________________________________________________________


 

 

EMAIL FROM DORA 4/2/2020 1:42PM


 

 

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Guidance for Chiropractic Procedures

Dear Chiropractic Licensee:

The State recognizes this is an unprecedented and difficult time for Coloradans. We are making every effort to ensure that all Coloradans are safe and receive the best possible care over the next weeks and months.

Governor Polis issuedExecutive Order (EO) D 2020 009(Order) to prioritize essential healthcare services, to help ensure access to necessary personal protective equipment and other medical supplies and notably in light of more recent actions, to promote safe personal distancing to reduce putting individuals at great risk of contracting COVID-19.

We are asking for all healthcare professionals to assess the essential need to provide services on a case-by-case, patient-by-patient basis to ensure compliance with the Order. To make your assessment, you need to consider that the only procedures or surgeries that are permissible under this Order are those that address the following:

  • There is a threat to the patient's life if the surgery or procedure is not performed;
  • There is a threat of permanent dysfunction of an extremity or organ system of the surgery or procedure is not performed;
  • There is a risk of metastasis or progression of staging of a disease or condition if the surgery is not performed; or
  • There is a risk that the patient's condition will rapidly deteriorate if the surgery or procedure is not performed and there is a threat to life, or to an extremity or organ system or of permanent dysfunction or disability.

As the March 27th guidance indicated, Executive Order D 2020 009doesallow for the discretion of the provider to conduct a chiropractic procedure in those circumstances where an injury or illness is at risk of progression or the patient’s health is at risk of rapid deterioration. You will note that DORA has also listed chiropractors as acritical service, provided that the services performed are within these confines of the Executive Order and are a conservative assessment of procedures that are critical on a case-by-case basis.

We recognize this is a difficult time, but we are asking all our professionals to comply with this order so that the spread of virus and the risk to our population is mitigated wherever possible. Thank you.

 

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Additional Information on Telehealth Services for Healthcare Professionals sent 4/13/2020 1:37 PM

 

 

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Division of Professions and Occupations Releases Additional Information on Telehealth Services for Healthcare Professionals

 

Dear Licensee:

In response to continuing COVID-19 developments, the Division of Professions and Occupations (Division), under the Department of Regulatory Agencies, has taken steps to implement Executive Order D 2020 020 issued by Governor Jared Polis. The Executive Order, issued on April 1, 2020, temporarily suspends certain statutes to expand the use of telehealth services due to the presence of Coronavirus Disease (COVID-19) in Colorado.

A large amount of provider-related guidance regarding telehealth is addressed on the Telehealth for Providers page, created by the Colorado Department of Public Health and Environment (CDPHE) in light of the Executive Order. However, DORA recognizes that our licensed professionals may have some lingering questions about how to undertake telehealth during the COVID-19 crisis.

Here is information that may prove helpful.

1. Which DORA-regulated professions fall under Executive Order D 2020 020?

Executive Order D 2020 020 explicitly mentions suspension of statutes related only to mental health and veterinary services providers. Nevertheless, the following healthcare professions also are able and encouraged to use telehealth in treatment of patients for the duration of this health emergency. Please note that, with the exception of veterinarians, providers must meet the definition outlined in Colorado Revised Statutes §10-16-102(56), which includes those “licensed or otherwise authorized to furnish healthcare services” as defined in §10-16-102(33).

  • Acupuncture

  • Addiction Counselor

  • Advanced Practice Nurse

  • Athletic Trainer

  • Anesthesiologist Assistant

  • Audiology

  • Certified Nurse Aide

  • Chiropractic

  • Dental

  • Direct-Entry Midwife

  • Hearing Aid Provider

  • Licensed Practical Nurse

  • Marriage and Family Therapy

  • Massage Therapy (if performed in a healthcare capacity, as ordered by a physician)

  • Medical

  • Naturopathic Doctor

  • Nursing

  • Nursing Home Administrator

  • Occupational Therapy

  • Optometry

  • Osteopath

  • Pharmacist

  • Pharmacy Intern

  • Pharmacy Technician

  • Physical Therapy

  • Physician

  • Podiatry

  • Professional Counselor

  • Psychology

  • Psychiatric Technician

  • Registered Psychotherapy

  • Respiratory Therapy

  • Social Work

  • Speech-Language Pathology

  • Surgical Assistant and Surgical Technology

  • Veterinary

2. What if telehealth is not sufficient to address the needs of my patients? Can I still conduct in-person appointments?

The professions listed above must still adhere to the mandates in Executive Order D 2020 027 (the amended version of Executive Order D 2020 009) prohibiting elective, non-emergency procedures**, as well as the social distancing requirements in Amended Public Health Order 20-24.

Governor Polis issued this Order to prioritize essential health care services, to help ensure access to necessary personal protective equipment (PPE) and other medical supplies, and to promote safe personal distancing to reduce putting individuals at great risk of contracting COVID-19.

We are asking all healthcare professionals to assess the essential need to provide services on a conservative, case-by-case, patient-by-patient basis to ensure compliance with the Order. To make an assessment, providers need to consider that the only procedures or surgeries that are permissible under this Order are those that address the following:

  • There is a threat to the patient's life if the surgery or procedure is not performed;

  • There is a threat of permanent dysfunction of an extremity or organ system of the surgery or procedure is not performed;

  • There is a risk of metastasis or progression of staging of a disease or condition if the surgery or procedure is not performed; or

  • There is a risk that the patient's condition will rapidly deteriorate if the surgery or procedure is not performed and there is a threat to life, or to an extremity or organ system or of permanent dysfunction or disability.

**Note: Rural and critical access hospitals are exempt from Executive Order D 2020 027, but are strongly advised to comply on a voluntary basis. Rural and critical access hospitals are, however, directed to comply with CDC guidelines for PPE preservation. Please refer directly to the order for further clarification in this area.

3. What insurance considerations must I be aware of before offering telehealth services?

The Division of Insurance within DORA has compiled a comprehensive list of questions and answers specific to recent emergency measures and allowances for private, commercial health insurance plans made according to Executive Order D 2020 020. View the Insurance FAQ on Telehealth Services for these considerations.

Note: Links to Colorado Healthcare, Policy, and Financing (HCPF) and Centers for Medicare and Medicaid Services (CMS) are provided in the above document with guidance for public insurance.

4. Can I continue providing services to people who may now be residing outside of Colorado (i.e. college students who returned to out of state homes) without getting in trouble?

Yes, as long as you hold an active license in the state of Colorado and have an existing relationship with a patient or client that was initiated in Colorado, Colorado will permit you to continue to provide telehealth services to clients who are temporarily residing in other states due to COVID-19. However, because the patient is residing in another state, you may want to contact that state’s licensure board to ensure similar allowances have been made there.

If you are aware of individuals who have returned home to Colorado and are hoping to continue receiving care from a provider who resides in a different state, Colorado is allowing this during the COVID-19 state of emergency. However, the out-of state provider should consult with his/her home state licensure board to ensure that similar allowances have been made there.

5. If I have a question that wasn’t addressed here, where can I go to get an answer?

General questions and concerns about telehealth/telemedicine licensure and practice requirements can be sent via email to DPO@state.co.us.

 

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EXECUTIVE ORDER AIDS STUDENT NURSES, CNAs; EXPANDS WORKFORCE DURING CRISIS SENT APRIL 16, 2020

 

 

 

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Temporary Regulatory Changes Smooth Nurse, CNA Pathways
to Graduation; Expand Available Healthcare Workforce Pool

Governor Jared Polis issuedExecutive Order D 2020 038on April 15, 2020, removing regulatory barriers that will provide nursing and nurse aide students in educational programs throughout Colorado avenues towards spring and summer graduation, while bolstering the ability of nurses and Certified Nurse Aides to enter or remain in the workforce.

Nursing student externs are also granted the ability to continue in paid positions as the state continues to prioritize essential healthcare services in lockstep with state agencies during the ongoing Novel Coronavirus (COVID-19) emergency.

The Executive Order, effective for at least 30 days, simultaneously authorizes the temporary expansion of scope of practice for healthcare professionals providing services for patients presenting to, or admitted to, hospitals or inpatient medical facilities - including emergency departments - during the pandemic as delegated by a physician, physician assistant, advanced practice nurse, certified nurse anesthetist, registered nurse, or respiratory therapist.

The expansion of the scope of regulated professionals will create necessary flexibility and an opportunity to fill critical inpatient gaps with regulated healthcare personnel, while providing a structured, well-supervised setting to ensure patient safety.

Healthcare professionals are statutorily required to work within a defined scope of practice, so inpatient facilities have previously been unable to use readily available personnel while Colorado is experiencing an unprecedented number of hospital admissions. Temporarily relaxing these restrictions via the Executive Order will allow for the cross-training of healthcare professionals and alleviate workforce shortages at hospitals and inpatient facilities, particularly in respiratory therapy and amongst critical care staff.

This Order does not expand scope of practice for healthcare professionals working outside of these healthcare settings.

Professionals allowed to fill these voids may now include: surgical assistants, surgical technologists, certified nurse aides (CNAs), physical therapists/assistants, occupational therapists/assistants, speech-language pathologists, podiatrists, optometrists, chiropractors, retired volunteer nurses, and dentists.

Anesthesiologist assistants, certified nurse anesthetists, advanced practice nurses, respiratory therapists, medical assistants, and physician assistants have increased authority under the Order as delegated by appropriate medical professionals. National speciality-practice certification requirements also may be waived for physicians and physicians assistants, widening their treatment capabilities.

Nursing students would have forfeited tuition, and in many cases been unable to enter the workforce in May, without a temporary suspension of Board of Nursing statutes and rules within the next week. Nurse aide students would have either lost their long-term care training positions, or completed their school-based program but would have been unable to enter the workforce.

Here is how the regulatory changes for nursing students will work in practice:

  • The Board of Nursing requires 750 clinical hours for Registered Nursing programs; 400 for Licensed Practical Nurses. Nursing student policy allowed students in a nursing education program to practice in a clinical setting while enrolled. But students were unable to get these clinical hours because facilities – such as hospitals, nursing homes, home health settings, and rehabilitation centers – were closed to students because of dwindling resources, health-related concerns, etc. Graduation is now possible through the Executive Order, which allows for several options. Nurses falling under these exceptions still must pass the written exam to be fully licensed in Colorado.
  1. a) An expansion past the normal allowance of 50 percent clinical simulation accepted towards clinical hours.b) Faculty or administrators at academic institutions may deem students competent to graduate with reduced clinical hours, based on a demonstrable skill set established over the course of their nursing education.c) Students volunteering their time and skills during the pandemic can count these hours towards clinical hours without faculty supervision, allowing them to complete courses which would result in them meeting the requirements for graduation.d) The Board of Nursing student extern policy allows students that are enrolled in a nursing education program to practice in a clinical setting while enrolled in a paid position for four months. These students may continue working, when normally they would be prohibited once they graduate.
  • First-year students excelling in their clinical work to date can progress to the second year without delay, as these provisions allow them to postpone half of their clinical hours until the fall, or by completing all clinical hours this semester through clinical simulation.
  • Board rules had prohibited the employment of an uncertified graduate of a nurse aide program for longer than four months until passage of the CNA test. Unavailability of the test due to test site closures prompted the Center for Medicare and Medicaid Services (CMS) to recently issue a waiver allowing nurse aides, once graduated, to work beyond 120 days, as long as they were in line to take the test for certification. The suspension of statutes in Colorado makes that possible.
  • Nurse aides may enter the workforce with a temporary certification from the State. The written and skills-based exammustbe completed prior to full certification, but will allow these students to enter the workforce.
  • Clinical hours for CNAs may be completed through simulation instead of a face-to-face setting.
  • Nursing students currently in their last semester are authorized to provide volunteer services delegated and supervised by a healthcare professional.

The Order also temporarily transferred exclusive emergency rulemaking authority over the medical, nursing, dental, chiropractic, podiatry, optometry, and physical therapy boards to the Director of the Division of Professions and Occupations, which should further assist students within additional professions who have been unable to test due to the indefinite postponement of exams.

Additionally, the Order helps ensure hospital pharmacies are able to meet expanding patient needs during the crisis by reducing restrictions on hospital satellite locations.

Please see theExecutive Order Question and Answer documentfor more details. For further inquiries or clarification on the emergency suspension of statutes and rules, please emaildpo@state.co.us.

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NOTICE REGARDING RESUMPTION OF ELECTIVE PROCEDURES SENT APRIL 24, 2020

 

 

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Further Guidance, Directives Upcoming for Safer-at-Home Phase

Dear Licensee:

Numerous questions have emerged in light of the announcement that the state will enter the Safer-at-Home phase in its recovery plan related to the COVID-19 pandemic.

As you may know, Governor Jared Polis’ Executive Order on theTemporary Cessation of All Elective and Non-Essential Surgeries and Procedures(Executive Order D 2020 027) expires on Sunday, April 26th. While we recognize that there is a pent-up demand for non-emergency and elective procedures, this is not a green light to immediately resume business as usual on Monday, April 27th. Rather, an executive order is expected from Governor Polis no later than April 27th providing further directives.

DORA stresses, however, that unless there is further official notice, you shouldnotexpect to change any of your current protocols on April 27th.Elective procedures should not take place until the Governor has issued these directives and businesses can ensure they can be fully implemented.

Further, the Governor’s lifting of statewide restrictions does not relieve you of continuing to comply with local public health orders if you work in a community where the local public health authority has extended restrictions on work or travel.

Following the Governor’s directive, DORA will communicate via email a comprehensive summary of state-level information and guidance specific to your industry.

As we navigate into this next stage, deliberation and the latest information must remain at the forefront before resuming operations. We appreciate your patience and cooperation as we work to collaboratively ensure the safest patient experience possible.

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