In support of New York’s ongoing COVID‑19 response efforts, Governor Andrew Cuomo has issued more than 80 executive orders that temporarily waive state regulatory requirements (waivers) or impose new mandates (directives), especially with respect to the healthcare industry. On December 13, Executive Order 202.82 added or expanded dozens of waivers and directives with the goal of increasing access to COVID-19 vaccines, as summarized below. With distribution of Pfizer’s vaccine underway—and Moderna’s vaccine on the horizon—these waivers provide crucial flexibility on requirements related to licensure, scope of practice, documentation and reporting as providers establish and operate COVID-19 immunization sites. Like all executive orders, these new vaccine-related provisions will expire automatically after 30 days unless renewed or amended.
Key Vaccine-Related Waivers and Directives
The following are some of the many new flexibilities introduced in Executive Order 202.82:
Standing Orders. Physicians and nurse practitioners (NPs) may issue standing orders for various types of health professionals—and in some circumstances, unlicensed individuals—to perform the following tasks (subject to meeting certain conditions and in accordance with any guidance that may be released by the New York State (NYS) Department of Health (DOH)):
- Collection of specimens for the purpose of COVID-19 or influenza testing
- Administration of COVID-19 vaccines
- Performance of any necessary nursing tasks to provide care for individuals diagnosed with or suspected of suffering from COVID-19 or influenza under the supervision of a registered nurse (RN) or licensed practical nurse (LPN)
Vaccine Administration at Point-of-Dispensing (POD) Sites. The following flexibilities are available at POD sites that are (1) under the jurisdiction of the DOH or local health departments, and (2) operated under the medical supervision of a physician, a physician’s assistant (PA) or an NP.
- The following practitioners may administer COVID-19 or flu vaccines pursuant to a standing order after completing requisite trainings: pharmacists (see below), midwives, emergency medical technicians (EMTs), EMT-paramedics providing community paramedicine services under supervision of a physician, dentists, dental hygienists with appropriate certifications and podiatrists.
- Students enrolled in certain healthcare educational programs—including medicine, RN, LPN, PA and pharmacy—may administer COVID-19 or flu vaccines pursuant to a standing order as long as they have at least one year of clinical experience and satisfy other requirements as may be established by the DOH or the NYS Education Department.
Pharmacists. Pharmacists certified to administer immunizations—as well as certain newly licensed pharmacists—may prescribe, receive and execute orders for COVID-19 vaccines, including both patient-specific and standing orders.
Supervision of Advanced Practice Clinicians. Executive Order 202.82 enhances existing waivers on scope of practice to allow PAs and NPs to administer COVID-19 and influenza vaccines and provide supervision of vaccine administration at a POD or other vaccination site.
Recordkeeping and Reporting
- Vaccination for either COVID-19 or influenza pursuant to a standing order need not be reported to the recipient’s attending physician, but must be reported to the NYS Immunization Information Registry (NYSIIS) or the City Immunization Registry (CIR) within 24 hours of administration.
- The governor has waived certain state law documentation requirements that would otherwise apply to COVID-19 or influenza vaccines. (This waiver does not affect any documentation requirements that may exist by virtue of participation in the federal COVID-19 Vaccination Program.)
Additional Waivers and Directives
- Redistribution of Vaccines and Supplies. Authorized vaccine providers in New York State may furnish federally supplied COVID-19 vaccine and ancillary supplies to other authorized in-state vaccine providers at no cost, subject to compliance with applicable storage and handling requirements and any other requirements established under federal and state law and guidance.
- Temporary Vaccination Sites. An existing waiver allows the DOH to bypass certain procedural requirements when approving construction applications for temporary hospital locations and extensions. Executive Order 202.82 clarifies that this waiver applies to temporary vaccination sites.
- Grandfathered Commercial Insurance Plans must cover any COVID-19 vaccine that has been recommended by the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices (ACIP).
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Manatt Health offers a subscription tracking resource for the healthcare content in New York’s executive orders, including the vaccine-related waivers described above as well as other recent waivers and directives pertaining to readmission of nursing home residents after temporary leaves of absence, requirements for hospitals to COVID-19-test patients before discharge to a long-term care facility, and flexibilities related to COVID-19 and flu testing.
In addition to receiving regular email updates summarizing new orders and flagging upcoming expiration dates, subscribers have access to an interactive tracking tool that lists waivers and directives along with details on affected provider types, expiration dates and amendments. For more information, please contact Meghan McNamara or Julian Polaris.