Spotlight PA: At last minute, Pa. lawmakers vote to extend dozens of COVID-19 waivers

This article was originally published on Spotlight PA.

by Danielle Ohl of Spotlight PA | Sept. 29, 2021

📷 FRED ADAMS / FOR SPOTLIGHT PA

HARRISBURG — The Pennsylvania legislature unanimously voted Wednesday to extend dozens of regulatory waivers put into place last year to help health-care providers fight COVID-19.

Without action, the waivers would have expired Thursday, potentially exacerbating ongoing staffing crises in hospitals and long-term care institutions, which are again facing rising COVID-19 cases. Health-care workers and their advocates had warned any lapse in the relaxed rules would have renewed administrative burdens and made fighting the ongoing pandemic more difficult.

Wednesday’s action will keep the waivers in place until March 2022 while the legislature considers a number of bills that would make the regulatory suspensions permanent. Gov. Tom Wolf will sign the bill.

“The governor is thankful the legislature engaged the administration and stakeholders and ultimately agreed with most of the administration’s recommendations on extending COVID-19-related waivers that are still in use,” spokesperson Lyndsay Kensinger said.

At the beginning of the pandemic, Wolf approved nearly 100 waivers to ease some of the rules governing health-care workers and ensure as many professionals as possible were on the ground in hospitals, vaccination clinics, and long-term care facilities.

The temporary changes were made under a disaster declaration that later became a target for legislative Republicans unhappy with the administration’s business closures.

Buoyed by two successful constitutional amendments that curtailed the executive’s power, the GOP-controlled General Assembly ended Wolf’s emergency order in June, while allowing the waivers to remain in place until Sept. 30.

Under the bill passed Wednesday, all suspensions under the Department of Health, Department of Human Services, and the Bureau of Professional and Occupational Affairs will remain in place until March unless Wolf and the agencies decide to terminate them sooner.

Among the waivers extended are those allowing out-of-state practitioners to treat patients in Pennsylvania, permitting retired or lapsed professionals to return to medicine, and expanding who can give a vaccine.

The waivers also allow patients to access care via telemedicine, which as of now is neither allowed nor prohibited in Pennsylvania law, creating a gray area for health-care providers and insurance companies.

Lawmakers have introduced bills in both the House and Senate to provide rules and regulations surrounding telemedicine, but past efforts have broken down over partisan disagreements. Wolf vetoed a telemedicine bill last year because it would have prevented health-care providers from prescribing abortion-inducing medicine.

As a number of other bills that would make regulatory suspensions permanent await consideration, two removing administrative barriers for physician assistants passed Wednesday.

The Joint State Government Commission is studying the impact of the waivers and which should stay in place to remove barriers to employment in the state. Glenn Pasewicz, executive director of the committee, said a report should be out by late October.

Separately, lawmakers on Wednesday directed various state agencies to post a report listing which waivers were and were not extended by Nov. 1.

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State Regulatory Waivers That Helped Hospitals, Health Care Providers During Pandemic Set To Expire

Published September 16, 2021 at 9:15 AM EDT

🎧 LISTEN • 22:30

📸: Jae C. Hong / AP

On today’s program: We hear how waivers that provided more flexibility and eased administrative burdens helped medical facilities face the pandemic, but they’re set to expire later this month; an obstetrician-gynecologist explains why a new bereavement leave policy for city employees will help those facing pregnancy loss; and a conversation about the increasing mental health needs of children and teenagers in the pandemic.

Medical waivers that lowered administrative barriers for health care workers set to expire (0:00 - 8:14)

Last year in the early weeks and months of the pandemic, hospitals and health care providers were swamped with patients who contracted COVID-19. Gov. Tom Wolf approved waivers to keep medical workers on the job and help bring in others, but those waivers are set to expire on Sept. 30.

“They were supposed to give a little bit of flexibility to people … [whose] jobs were upended or they were on the frontlines of fighting COVID,” says Danielle Ohl, a reporter with Spotlight PA.

One example of how these waivers worked is nurses or doctors with lapsed licenses could return to work in facilities, removing some administrative barriers.

Nearly 100 such waivers were implemented, however, Ohl says there isn’t good data on how many people used them.

Should the waivers not be extended, Ohl says boards that govern professions with waivers will be overwhelmed.

“In the most dire case, a nurse could be pulled off the floor because their paperwork didn’t go through or it expired,” says Ohl. “There is just a fear that the administrative burden isn’t going to be dealt with and they don’t really know what that means, and they don’t want to take a chance in breaking the law.”

Ohl says the legislature could extend the waivers, but it’s unclear if that will happen while the legislature is currently out of session.

Expiring COVID-19 waivers could make Pa. health-care staffing shortages worse

by Danielle Ohl of Spotlight PA | Sept. 13, 2021

HARRISBURG — Regulatory waivers established last year to help hospitals and health-care workers fight COVID-19 will expire this month, and those in the field are warning the lapse could exacerbate an ongoing staffing crisis as coronavirus cases rise again.

At the beginning of the pandemic, Democratic Gov. Tom Wolf approved nearly 100 waivers to ease some of the rules governing health-care workers and ensure as many professionals as possible were on the ground in hospitals, vaccination clinics, and long-term care facilities.

Photo: FRED ADAMS / FOR SPOTLIGHT PA

They included allowing out-of-state practitioners to treat patients in Pennsylvania, permitting retired or lapsed professionals to return to medicine, and expanding who could give a vaccine.

The temporary changes were made under a disaster declaration that later became a target for legislative Republicans unhappy with the administration’s business closures.

Buoyed by two successful constitutional amendments that curtailed the executive’s power, the GOP-controlled General Assembly ended Wolf’s emergency order in June, while allowing the waivers to remain in place until Sept. 30.

The legislature will reconvene this month, and leadership in the House and Senate have said lawmakers will consider whether some waivers should be made permanent.

But as coronavirus infections continue to spike among the unvaccinated, those in the health-care field worry even a temporary lapse of the loosened rules they’ve come to rely on for the past year and a half will only prolong the pandemic they’ve fought to overcome.

“To lose those waivers we’ve relied on as another surge is coming, as new variants are coming to long-term care, that would create a real challenge across the state,” said Zach Shamberg, president and CEO of the Pennsylvania Health Care Association, which lobbies on behalf of long-term care facilities in the state. “We need those waivers until we can get out of this.”

It’s impossible to know how many people took advantage of the waivers, as the Department of State — which oversees professional licensing in Pennsylvania — did not track that information. Agency spokesperson Ellen Lyon said the waivers aimed to mobilize a larger workforce against the COVID-19 pandemic without creating new document-filing requirements.

But more than half a dozen health-care workers and industry advocates told Spotlight PA some of the relaxed regulations helped ease staffing shortages and deliver care during the pandemic.

Betsy Snook, a nurse and CEO of the Pennsylvania State Nurses Association, said online continuing education courses have provided flexibility for nurses who need the credits to stay licensed.

She also pointed to a waiver allowing nurse practitioners to see patients and collaborate with multiple doctors within the same hospital system without needing additional written agreements, which she said expanded the care those nurses can provide. Snook said she worries the nursing board that approves the agreements will be overwhelmed once the waiver disappears.

State licensing boards, industry groups, and Department of State staff last year asked the Wolf administration to consider waiving some requirements and regulations that were either no longer possible to comply with due to the pandemic or hindering pandemic response, according to Lyon. The administration ultimately relaxed rules that govern dozens of workplaces, including barbershops, salons, dentist offices, and funeral homes.

Some of those industries have returned to a semblance of normalcy, advocates said, so the waivers in place over the past 18 months are no longer needed. The same cannot be said for hospitals and long-term care facilities, where professionals said staffing shortages that existed before the pandemic have become much worse.

“Caring for people is really tough work physically and emotionally,” said Georgia Goodman, director of government affairs for LeadingAge PA, a group that lobbies on behalf of nonprofit long-term care facilities. “A lot of staff we had left the field altogether, some had some early exits. It’s an awful storm.”

Michelle Boyle, a Pittsburgh-area nurse and former state Senate candidate, said in her decades in the field, she’s never seen nurses look so hollowed out.

“If you hollow something out, it’s just going to collapse,” she said.

Boyle, who is a member of SEIU Healthcare Pennsylvania, said allowing nurses to delay obtaining continuing education credits was helpful, as health-care workers were already “over their hours on a regular basis.”

But, she argued, the legislature needs to make meaningful changes that will make patients and the people charged with caring for them safer in order to retain staff.

Staffing shortages in the health-care field are a national problem, with difficult working conditions, burnout, and a highly competitive marketplace fueling the issue.

“If you look at almost any hospital in Pennsylvania, there are many, many, many job openings for these positions,” said Warren Kampf, senior vice president of the Hospital and Healthsystem Association of Pennsylvania.

“Hospitals are paying retention bonuses, paying bonuses to sign and they can’t fill them.”

COVID-19 infection rates have been rising nationwide, and though Pennsylvania has one of the nation’s lowest per-capita case rates, infections here are creeping up as well.

Pennsylvania recorded more than 4,500 new coronavirus cases Friday, a daily tally not seen since the spring. Hospitalizations are on the rise as well, with 1,926 patients in beds Friday and 236 on ventilators.

Patients who have been deferring care are returning to hospitals, flu season is starting, and emergency rooms are filling up with patients as public activity resumes, Kampf said. Staffing has been difficult even with the waivers.

“With nurses, physicians, [physician assistants], everyone in the hospital working like crazy under intense pressure, there are a lot of shortages out there,” he said. “You put all that together and it’s very tough to operate.”

When lawmakers return to Harrisburg this month, health-care advocates are hopeful there will be quick action to make some of the waivers, including one that permits doctors to use telemedicine, permanent. The state House committee on Aging and Older Adult Services will hold a hearing Monday to discuss how the lapsed waivers affect older Pennsylvanians.

But above all, those who spoke with Spotlight PA said permanent solutions are needed to ensure nurses, doctors, and frontline health-care workers can stay in their positions.

“The nursing shortage is probably the most important thing,” Snook said. “No matter how many beds we have, if we don’t have nurses, patients will die.”