*this content was last updated as of Monday, March 23 at 12:00 p.m. CST

As we continue to live with the COVID-19 public health emergency, several states have acted over the course of the last week to implement stay at home orders for their residents, which include the closing of non-essential businesses and services. In addition, an even larger number of states have acted quickly to relax licensure requirements for healthcare professionals and allow them to practice across state lines.

Stay at Home Orders

As of the time of this publication, the following states have implemented “stay at home” or similar orders:

California: On March 19, 2020, Governor Gavin Newsom issued California Executive Order N-33-20, ordering all residents to comply with the State Department of Public Health Order that requires residents to stay at their places of residence. Californians working in one of the 16 critical infrastructure sectors, including both public and private healthcare, may continue their work. Healthcare services and resources, including the use of personal protective equipment, shall be prioritized to those who are the sickest. The executive order was effective upon issuance and remains in effect until further notice. Refusal to comply with, or willful neglect of, the executive order is a criminal misdemeanor punishable by fine or imprisonment.

Connecticut: On March 20, 2020, Governor Ned Lamont issued Executive Order No. 7H, requiring all non-essential businesses and nonprofits to reduce in-person workforces by 100% and employ remote working arrangements for personnel no later than 8:00 p.m. on March 23, 2020. Restrictions on in-person workforces will remain in effect through April 22, 2020 for businesses and nonprofits other than those deemed essential (e.g., hospitals, clinics, pharmacies, home health and elder care and businesses in other critical sectors). Other businesses may request an opinion from Connecticut’s Department of Economic and Community Development to allow in-person workforces to continue at full capacity. Governor Lamont’s Stay Safe, Stay Home initiative gives additional guidance to Connecticut residents, directing them not to leave their homes for medical care unless advised to do so during a telehealth visit with a healthcare professional.

Delaware: Governor John Carney issued modifications to his State of Emergency declaration on March 22, 2020. The fourth modification directed Delaware residents to stay home unless engaged in essential activities, and the fifth modification directed non-essential businesses to close, in each case effective at 8:00 a.m. on March 24, 2020 until May 15, 2020. A detailed list of essential and non-essential businesses as defined by the Office of the Governor is available here; businesses providing healthcare and social assistance services may continue in-person operations at this time. Failure to comply with these recent measures amounts to a criminal offense.

Illinois: Governor J. B. Pritzker issued Illinois Executive Order 2020-10 on March 20, 2020, requiring all individuals to stay in their place of residence and banning large gatherings, except to carry out certain essential activities (e.g., seeking urgent public safety services and medical care, obtaining necessities, working in limited essential businesses and caring for vulnerable populations). Essential businesses permitted to remain in operation include pharmacies, hospitals, clinics, physician and dental practices, home health services, behavioral/mental health and substance use providers, long-term care facilities, and residential facilities, among others. The order became effective on March 21, 2020 at 5:00 p.m. and will remain in effect through April 7, 2020.

Indiana: On March 23, 2020, Governor Eric J. Holcomb issued Executive Order 20-08 directing Indiana residents to stay home and refrain from non-essential activities and travel starting March 24, 2020 at 11:59 p.m. and ending April 6, 2020 at 11:59 p.m. Businesses are to encourage personnel to operate on a remote basis other than those businesses operating in certain critical sectors (including, but not limited to, healthcare and human service providers, residential facilities and pharmacies).

Louisiana: On March 22, 2020, Governor John Bel Edwards issued Proclamation No. JBE 2020-33, amending Proclamation No. JBE 2020-30 issued on March 16, 2020, to tighten the limitations on large gatherings and expand the list of non-essential businesses instructed to close. Residents are directed to stay at home unless engaged in certain essential activities or working in a critical sector. The limitations imposed by the order do not extend to normal operations at medical facilities.

Michigan: Governor Gretchen Whitmer issued Executive Order 2020-21 on March 23, 2020, directing Michigan residents to stay home unless engaged in certain essential activities. Such activities including reporting to work for certain critical infrastructure workers (e.g., workers in the healthcare, public service and community operations sectors and certain workers in the insurance industry). The order takes effect on March 24, 2020 at 12:01 a.m. and will remain in effect through April 13, 2020 at 11:59 p.m. Violation of the terms of the order constitutes a criminal misdemeanor.

New Jersey: On March 21, 2020, Governor Phil Murphy issued Executive Order No. 107, which requires New Jersey residents to stay home unless engaged in certain essential activities. Businesses and nonprofits are directed to facilitate remote working arrangements for personnel, and if impracticable, then onsite workforces must be reduced to the minimum number necessary to continue essential operations. Noncompliance with the order could result in criminal penalties. The limitations imposed by the order are not to restrict the provision of medical care or access to essential human services for New Jersey residents.

New York: Governor Andrew Cuomo’s New York State on PAUSE Executive Order, directing all non-essential businesses to close and banning all non-essential gatherings, went into effect at 8 p.m. on March 22, 2020. Vulnerable populations in the state are now subject to Matilda’s Law, which strongly discourages use of public transportation and limits home visits to immediate family members in urgent circumstances, provided that any such visitors have been prescreened for flu-like symptoms.

Ohio: Department of Health Director, Dr. Amy Acton, issued a Stay At Home Order on March 22, 2020 directing Ohio residents to stay at home unless engaged in certain essential activities, business operations and public functions, effective at 11:59 p.m. on March 23, 2020 through 11:59 p.m. on April 6, 2020. Individuals are permitted to leave their homes to work for or receive services from healthcare and human service providers and to engage in other essential activities and operations.

Puerto Rico: On March 15, 2020, Governor Wanda Vázquez issued Administrative Bulletin No. OE-2020-023, requiring individuals to remain in their homes and directing all non-essential businesses and governmental operations to close until March 30, 2020. Individuals may leave their homes to obtain necessities and medical care, report to work if engaged in essential operations, assist citizens in vulnerable populations, or visit financial institutions. Residents are subject to a 9:00 p.m. curfew; however, exceptions are made for emergencies and personnel engaged in essential health and public service operations. Law enforcement personnel are given explicit authority to enforce the terms of the order. Residents who fail to comply with these terms could face criminal penalties and fines.

Tennessee: On March 22, 2020, Governor Bill Lee issued Executive Order No. 17, directing businesses to put remote working arrangements in place for personnel to encourage individuals to stay at home unless engaged in certain essential activities. To protect vulnerable populations, the “Safer at Home” order implements visitor restrictions for residential care facilities (e.g., nursing homes, long-term care and assisted living facilities) and encourages businesses to reserve certain hours for more citizens who are more vulnerable to communicable diseases. The order became effective at 12:01 a.m. on March 23, 2020 and will remain in effect until 12:01 a.m. on April 6, 2020. Learn more about similar measures being taken by local authorities in Nashville, Tennessee here.

Relaxation of Licensure Requirements

• The following states and the District of Columbia have implemented the relaxation of licensure requirements to allow healthcare professionals to practice across state lines: Alabama, Arizona, California, Colorado, Florida, Georgia, Hawaii, Idaho, Indiana, Iowa, Kentucky, Louisiana, Maryland, Massachusetts, New Hampshire, New Jersey, New Mexico, New York, North Carolina, North Dakota, Oregon, Rhode Island, South Carolina, Tennessee, Texas and Washington.
• Delaware and Mississippi have issued guidance allowing out-of-state providers to practice telemedicine in the state.
• Oklahoma has waived the requirement of a pre-existing physician-patient relationship prior to the implementation of telemedicine.

As the nation braces for a spike in COVID-19 cases, other states are sure to follow suit in the coming days and weeks. A summary of state-level waivers of licensure requirements in light of the COVID-19 pandemic is available has been prepared by the Federation of State Medical Boards and is available here. More information about waivers issued at the federal level for requirements having broad applicability is available here.