° making, amending and rescinding the necessary orders, rules and regulations to carry out the response to a public health disaster emergency;

° suspending the provisions of any regulatory statute prescribing the procedures for conduct of state business, including the orders, rules or regulations of any state agency if strict compliance with any of these provisions would in any way prevent, hinder, or delay necessary action in coping with the emergency;

° transferring the direction, personnel, or functions of state departments and agencies or units for performing or facilitating emergency services; and

° using any and all available resources of state government and of each political subdivision of our State as reasonably necessary to cope with the public health disaster emergency;

1. Duration of this Executive Order

The directives in this Executive Order become effective October 1, 2021, at 12:01 a.m. and continue through 11:59 p.m. on October 31, 2021, and all Hoosiers, Hoosier businesses, and other individuals in the state must adhere to the directives set forth in this Executive Order unless rescinded, modified, or extended by me.

2. Directives in Executive Order 21-17 Continued Again

a. As previously extended in Executive Order 21-19 [20210804-IR-GOV210337EOA], 21-23 [20210908-IR-GOV210396EOA] and 21-24 [20210908-IR-GOV210397EOA], the directives in Executive Order 21-17 [20210804-IR-GOV210339EOA], subject to the modifications outlined below, will remain in effect for the duration of this Executive Order.

b. The continued directives that remain in effect pertain to:

i) licensing of health care workers and students who have been granted a temporary license, however, such temporary licenses are now extended through December 31, 2021 (EO 21-17 ¶ 3);

ii) registration requirements for certain Indiana or out-of-state health care providers (EO 21-17 ¶ 4);

iii) insurance coverage for temporarily licensed out-of-state health care providers (EO 21-17 ¶ 5);

iv) expansion of those permitted to administer COVID-19 vaccinations and PREP Act immunity for those providing vaccinations (EO 21-17 ¶ 6);

v) the Family and Social Services Administration's (FSSA) implementation of the Indiana Medicaid, HIP, CHIP and Medworks programs (EO 21-17 ¶ 7(a), (b), (e));

vi) the Department of Workforce Development's (DWD) provision on augmentation of its workforce, which continues and remains in effect for as long as it remains authorized and permitted by federal law (EO 21-17 ¶ 8(b)); and

vii) completion dates for law enforcement training at the Indiana Law Enforcement Academy (EO 21-17 ¶ 9).

c. The provision in paragraph 7(c) of Executive Order 21-17 [20210804-IR-GOV210339EOA] pertaining to the job search requirements for the Temporary Assistance to Needy Families (TANF) program remains rescinded.

d. The provision in paragraph 7(d) of Executive Order 21-17 [20210804-IR-GOV210339EOA] pertaining to prescribing amounts for opioid take-home medications remains rescinded.

e. The provision in paragraph 8(a) of Executive Order 21-17 [20210804-IR-GOV210339EOA] pertaining to the suspension of the one week waiting period before paying unemployment benefits to claimants remains rescinded.

f. The provisions in paragraph 10 of Executive Order 21-17 [20210804-IR-GOV210339EOA] pertaining to waiver of penalty and interest in taxation of unemployment compensation by the Indiana Department of Revenue is rescinded.

3. Advanced Practice Registered Nurses

An Advanced Practice Registered Nurse is permitted to provide services in multiple locations as long as they have an existing collaborative agreement on file. The relevant provisions in Ind. Code § 25-23-1-19.4 and 848 IAC 5-1-1(a)(7)(F) are suspended to effectuate this directive.

4. Hospitals: Non-Emergent Procedures & Reporting Requirements

a. Non-Emergent Procedures:

Due to the current strain on our health care system, hospitals are directed to implement evidence-based criteria to ensure sufficient capacity and staffing to care for all patients, and where necessary, should reprioritize or postpone non-emergent surgeries or procedures. Hospitals should consult the best practices and recommendations developed by their respective medical associations and industries in making this assessment.

b. Reporting:

Hospitals must report the following to the IDOH's EM Resource system to allow for capacity and resource availability monitoring:

i) diversion status must be reported as directed by the IDOH;

ii) number of hours spent in diversion for Emergency Departments (ED) and critical care units for the previous day must be reported daily; and

iii) in order to assist hospitals with coordination and resources to aid facility to facility transfers, all information required by the Department of Health and Human Services, including number of available beds, Intensive Care Unit (ICU) beds, pediatric beds, pediatric ICU beds, and ventilator availability, must be reported daily.

5. License Renewals for Physicians and Nurses

a. Physicians and Osteopathic Physicians

Physicians and Osteopathic Physicians will be afforded an additional thirty (30) days past the October 31, 2021, deadline for renewal of his or her medical license and any license for prescriptive authority including any affiliated Controlled Substance Registry, and I suspend the relevant provisions of Ind. Code Ch. 25-1-2, Art. 25-22.5 and 844 IAC 4-6-1 & 6 and any other relevant provision to the extent necessary to allow this additional time for such licenses.

b. Registered Nurses, Advanced Practice Registered Nurses, and Nurse Midwives

Registered Nurses, Advanced Practice Registered Nurses, and Nurse Midwives will be afforded an additional thirty (30) days past the October 31, 2021, deadline for renewal of his or her nursing license and any license for prescriptive authority including any affiliated Controlled Substance Registry, and I suspend the relevant provisions of Ind. Code § 25-23-1-16.1 and any other relevant provision to the extent necessary to allow this additional time for such licenses.

6. Insurance & Prior Authorizations

a. Extension of Prior Authorizations of Certain Non-Emergent Procedures

I direct the Commissioner of the Indiana Department of Insurance (IDOI) to request that insurers issuing accident and sickness insurance policies, as defined in Ind. Code § 27-8-5-1, and health maintenance organizations, as defined in Ind. Code § 27-13-1-19, extend prior authorization timeframes for open and approved authorizations. This extension applies only to prior authorizations for non-emergent surgeries or procedures postponed to ensure sufficient COVID-19 response capabilities.

b. Prior Authorizations for Transfer or Discharge of Patients

To expedite and facilitate the transfer of patients from hospitals to the most appropriate setting, including post-acute placement and home-based, I further direct the IDOI Commissioner to request that insurers issuing accident and sickness insurance policies, as defined in Ind. Code § 27-8-5-1, and health maintenance organizations, as defined in Ind. Code § 27-13-1-19, waive clinical information requirements for prior authorizations for such transfers or discharges.

7. COVID-19 Control Measures for Institutions and Congregate Care Facilities

a. COVID-19 Control Measures:

The IDOH, pursuant to Ind. Code § 16-41-2-1 and 410 Ind. Admin. Code § 1-2.5-79, has issued measures to control COVID-19. The measures require institutions and congregate care facilities, including K-12 educational institutions, post-secondary facilities, long-term care facilities, jails, prisons, childcare facilities, and other congregate settings to report all known positive COVID-19 cases in a manner prescribed by the IDOH. This reporting measure is also required by Commissioner Order # CO 21-01. The control measures further require case investigation and contract tracing as well as appropriate isolation of those who test positive for COVID-19 and quarantining of close contacts. The COVID-19 Control Measures are found at: https://www.in.gov/health/erc/files/COVID-19-Control-Measures-under-410-IAC-1.pdf.

b. K-12 Educational Institutions & Child Care Facilities:

i) Local Restrictions and Measures to Address COVID-19

Subject to pertinent statutory provisions, Executive Order provisions, local ordinances and directives, and/or state or local health orders, local school boards and/or the relevant governing bodies of all public and private K-12 educational institutions and childcare facilities are responsible for implementing local measures and restrictions to address the impact and spread of COVID-19 in their buildings, facilities, and grounds. These restrictions and measures may be more restrictive, but not less restrictive, than required by statute, Executive Orders, local ordinances and directives, and state or local health orders. The IDOH has updated its school guidance to assist local school corporations and this guidance may be found at: https://www.coronavirus.in.gov/2400.htm.

K-12 educational institutions and childcare facilities must continue to perform contact tracing activities, provide parental notification to close contacts to allow for monitoring of symptoms, and report all known positive COVID-19 cases to state and local health departments and their regulatory agencies such as the Family and Social Services Administration as required by this Executive Order and Commissioner Order # CO 21-01.

ii) Modification of Quarantine Requirement for Close Contacts in K-12 Educational Institutions and Childcare Facilities

I direct the Commissioner of IDOH to evaluate, and modify where warranted, the quarantine provisions for 1) individuals who are close contacts of a COVID-19 infected person in K-12 educational institutions and childcare facilities that 2) adhere to measures and protocols to control COVID-19 set forth in IDOH's orders and guidance.

8. For All Hoosiers and Individuals within the Hoosier State

a. Individual Responsibility:

All Hoosiers and each and every person within the Hoosier state should take responsibility for their safety and the health and safety of those around them by taking appropriate preventative measures. This is particularly important due to the high transmissibility of the Delta variant of COVID-19.

b. Vaccination:

Unvaccinated individuals are the most at risk for serious illness, hospitalization and death. Since January 2021, 93% of new COVID-19 cases are with unvaccinated individuals. All Hoosiers, age 12 and above, are strongly encouraged to obtain a COVID-19 vaccination which will be provided at no cost. Hoosiers can locate a vaccination site by calling 2-1-1 or visiting www.ourshot.in.gov. Anyone younger than 18 years of age may only receive the Pfizer vaccine. The COVID-19 vaccination has proven to provide the single best protection from serious illness and hospitalization caused by the COVID-19 infection.

c. Individuals with COVID-19 Symptoms:

Hoosiers and others in the Hoosier state who are symptomatic, whether fully vaccinated or unvaccinated, should get tested for COVID-19. Individuals who test positive shall isolate according to IDOH guidelines. Individuals who are symptomatic and test negative should isolate until their symptoms have resolved.

d. Close Contacts of Individuals with COVID-19:

A close contact is someone who was within 6 feet of a COVID-19 infected person for a cumulative total of 15 minutes or more over a 24-hour period.

Fully vaccinated individuals who are close contacts of a person who tests positive for COVID-19 may continue their normal activities but must wear a mask at all times in public until they test negative 3-5 days after exposure or until 14 days have passed.

Unvaccinated individuals who are close contacts of a COVID-19 infected person shall quarantine, if required, according to IDOH guidelines.

9. No Limitation on Authority

Nothing in this Executive Order shall, in any way, alter or modify any existing legal authority allowing the State, any local health department, or any other proper entity from ordering: (a) any quarantine or isolation that may require an individual to remain inside a particular residential property or medical facility for a limited period of time, including the duration of this public health emergency; or (b) any closure of a specific location for a limited period of time, including the duration of this public health emergency.

10. Local Declarations of Emergency

Pursuant to the Emergency Disaster Law, no local ordinance, directive, or order of any county, political subdivision, or other local government entity pertaining to this public health emergency, may contradict or impose less restrictive requirements than those set forth in this Executive Order, or else that ordinance, directive, or order will be void and of no force or effect. However, unless prohibited by an Executive Order, local ordinances, directives, and orders may be more restrictive provided they comply with Ind. Code §§ 16-20-1-21.5 and 16-22-8-31.3.

11. Savings Clause

If any provision of this Executive Order, or its application to any person or circumstance, is held invalid by any court of competent jurisdiction, this invalidity does not affect any other provision or application of this Executive Order, which can be given effect without the invalid provision or application. To achieve this purpose, the provisions of this Executive Order are hereby declared to be severable.

DIN: 20211110-IR-GOV210481EOA

Composed: Apr 25,2024 8:26:26PM EDT

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