• States Limiting Elective Procedures in Hospitals, Resuming Surgery in All Settings


    The rapid surge in COVID-19 cases across the United States has prompted officials in three Sun Belt states to halt elective surgeries in at least some counties and local health care officials in at least seven more states to slow or halt nonurgent procedures.

    • Officials in Mississippi and New Mexico have halted elective procedures across the state.
    • Texas’ governor has temporarily banned hospital-based surgeries in 105 counties and across 11 of the state’s 22 “trauma service areas.”
    • Individual hospitals in Alabama, Arizona, California, Florida, Georgia, Nevada and South Carolina have voluntarily paused or delayed surgeries.
    • News reports suggest some facilities in Montana and Tennessee could soon halt elective procedures.

    In most cases, the hospitals, not states, are imposing restrictions on in-hospital elective procedures. The Academy’s research prioritizes state and local orders affecting procedures. In cases of voluntary closures, we cite hospital or facility announcements when possible, confirmed by national and local news reports. We also reviewed a number of state-by-state lists maintained by industry sources, legal reviews and national and local news media.

    Requirements in other states vary, but share some common features.

    • Most states want you to have or obtain sufficient protective equipment, without affecting local government resources.
    • You should also ensure appropriate hygiene/cleaning, signage and social distancing, where possible.
    • Some states recommend or require a negative COVID-19 test result or lack of contact with an infected person prior to surgery.

    State-by-state Listing

    The following state-by-state update is current as of July 16.

    Information about the following states was updated July 16: Mississippi, New Mexico and Texas.

    Information about the following states was updated July 9: Arizona, Florida, Mississippi and Texas.

    Information about the following states was updated June 4: Colorado, Connecticut, Delaware, Georgia, Idaho, Massachusetts, Michigan, Nebraska, Nevada, New Jersey, Washington and Washington, D.C.

    Information about the following states was updated May 14: Delaware, Hawaii, Illinois, Louisiana, Nevada, New Hampshire, New Mexico, New York, Vermont, Washington and Wisconsin.

    Information about the following states was updated May 7: Alabama, Arkansas, Idaho, Indiana, Iowa, Kansas, Maine, Maryland, Minnesota, Missouri, Montana, Nebraska, North Carolina, North Dakota, Pennsylvania, Rhode Island, South Dakota, Texas, West Virginia and Wyoming.

    See a map of states that are reopening.

    Alabama

    Under an order (PDF) that took effect April 30, providers can resume elective procedures as long as they don’t “unacceptably reduce access to personal protective equipment or other resources necessary to diagnose and treat COVID-19.”

    Alaska

    Under the updated health mandate (PDF):

    • “Low-risk, routine-type services” could resume April 20.
    • “Nonurgent/nonemergent elective surgeries and procedures” could resume May 4, subject to certain conditions.

    Arizona

    Under an April 22 executive order (PDF), providers who meet minimum criteria may resume elective surgeries May 1. Criteria include having more than a 14-day supply of personal protective equipment separate from state or county resources. By early July, however, many hospitals had exceeded the COVID-19 capacity limit for elective procedures. A July 6 news report said most Phoenix-area hospitals had once again stopped all but urgent and emergent care.

    Arkansas

    Effective April 27 (PDF), providers could resume elective procedures, subject to conditions including:

    • “No contact with known COVID-19 patients during the past 14 days”; and
    • “At least one negative COVID-19 NAAT test within 48 hours prior to the beginning of the procedure.”

    Providers also must have adequate protective equipment on hand.

    California

    The state’s stay-at-home order on April 22 (PDF) lets health care providers resume some elective surgeries.

    Colorado

    A 30-day mandate issued April 27 (PDF) permits “limited recommencement of voluntary or elective surgeries and procedures.” The original mandate expired May 26, when the governor extended it to June 25.

    Connecticut

    The governor never barred elective procedures by order, but a state spokesperson told NBC News that providers could resume such procedures in early May.

    Delaware

    Under the governor’s plan to reopen the state, elective procedures resumed in phase one, which commenced June 1 (PDF).

    Florida

    Elective surgeries could resume after a scheduled May 4 reopening (PDF). By early July, however, news reports indicate that some health care systems have slowed elective procedures again. Effective July 6, HCA Healthcare suspended elective surgeries in its hospitals in Pinellas County. BayCare Health System began reducing such surgeries in the same county beginning July 10. Memorial Healthcare System halted all but urgent and urgent procedures effective July 8.

    Georgia

    The executive order effective May 1-13, “Reviving a Health Georgia” (PDF) included two pages on reopening health care services. It named few specific settings and providers, but did direct:

    • Optometrists to follow specific national and state society guidelines.
    • Opticians to follow disinfection and employer recommendations from the Centers for Disease Control and Prevention.
    • Ambulatory surgical centers to implement several measures to “prevent the spread of COVID-19 as practicable.

    The most recent guidance, effective June 1-15 (PDF), provided guidelines for health care providers on pages 24-26.

    Hawaii

    Under an April 16 order (PDF), the governor directed health care providers to cancel or postpone elective surgeries “as each facility determines to be appropriate under the circumstances presented by the COVID-19 emergency.” According to news reports, some hospitals have begun to resume such procedures.

    Idaho

    Under stage one of the state’s plan, effective May 1-15, businesses have to ensure social distancing, “provide adequate sanitation and personal hygiene” and “provide services limiting close interactions with patrons.” Stage two, in effect May 16-26, includes additional guidance for “close contact services” (PDF). The state, which moved to stage three May 30, has not released specific guidance for health care providers.

    Illinois

    Under updated health department guidance, hospitals and ambulatory surgical centers could resume elective procedures May 11. Conditions of resumption include preoperative COVID-19 testing, infection-control measures and a sufficient supply of personal protective equipment.

    Indiana

    An April 24 executive order (PDF) that took effect April 26 permits elective procedures as long as health care providers have enough protective equipment and “have adopted policies and best practices” to prevent COVID-19 infections.

    Iowa

    An April 24 order effective April 27 allows some resumption of elective procedures, based on need for personal protective equipment:

    • No stated limits on procedures
    • Required: The procedure must “pose a significant risk to quality of life” if delayed and the provider/facility should be able to perform it without effect on state or local equipment supplies.

    The order also directs providers to conserve such equipment as possible.

    Kansas

    Under an April 30 order, the state eased restrictions on business and gatherings, subject to social distancing, cleaning and a 10-person limit on groups. The order does not address elective procedures but continued the closure of non-essential “personal services businesses where close contact cannot be avoided.” View state guidance and resources for health care providers.

    Kentucky

    As announced April 27, providers can begin a multiphase return to normal operations, subject to infection-control restrictions.

    • May 6: Resume “outpatient surgeries and other invasive procedures.”
    • May 13: Resume other "non-emergency surgeries and procedures," up to half of pre-pandemic volume.

    The state plans to enter the final phase of health care reopening May 27. Read the whole plan (PDF).

    Louisiana

    Under an order (PDF) that took effect April 27, providers could resume procedures for “time-sensitive medical conditions,” subject to conditions including preoperative COVID-19 screening, social distancing, adequate protective equipment and other measures. The state moved to phase one of its reopening plan (PDF) May 15, which includes social distancing and use of face masks in public.

    Maine

    Health care providers may reopen in stage one of the state’s plan (in effect for May), if they do so “safely and gradually.” Per April 30 guidance (PDF) for the industry, providers should ensure they have adequate protective equipment to reopen and only use state-provided materials for “emergencies.”

    Maryland

    As announced May 6 (PDF), health care providers could resume elective surgery May 7, subject to certain requirements, including having a one-week supply of personal protective equipment, screening staff and patients for COVID-19 symptoms and maintaining social distancing whenever possible.

    Massachusetts

    “Less urgent preventative services, procedures and care” can resume in phase two of the governor’s reopening plan. The governor planned to announce the state of this phase by June 6. Phase one allowed hospitals and community health centers to resume “high priority preventative care” for some patients on May 18, subject to attestation. “Additional health care providers” could do the same as of May 25.

    Michigan

    Under a state order issued May 21, providers could resume elective procedures effective May 29. The order rescinded the earlier restriction on such procedures and laid out several general requirements for resumption of certain activities.

    Minnesota

    Under a May 5 order (PDF) effective May 10, providers could expand the services they offer, subject to development of a plan for prioritization, use of protective and equipment and steps to screen and protect both patients and employees. View the state guidelines for developing a plan (PDF).

    Mississippi

    • The April 24 order (PDF) to start reopening the state permits elective surgeries and procedures requiring “minimal disposable personal protective equipment.” Providers cannot ask “any public source, whether federal, state or local” for more such equipment to do elective procedures.
    • On July 7, the Mississippi State Department of Health on Wednesday froze elective surgeries in six counties, according to news reports.
    • On July 10, the state health department ordered postponement (PDF) of all “tier 1 or 2” surgeries until after at least July 20.

    Missouri

    Under an April 27 health order (PDF), “every person and business” has to stay at least six feet from others. Those whose job requires closer contact “should take enhanced precautionary measures to mitigate the risks of contracting or spreading COVID-19. This provision shall apply in all situations.”

    Montana

    At least one news organization is reporting resumption of some elective procedures, but the hospital association that recommended suspension hasn’t formally announced a change in policy.

    Nebraska

    Per guidance released April 24 (PDF), providers could resume elective procedures May 4, subject to restrictions in place through at least May 31. The clause covering elective procedures appears on page 4. All but four counties moved to phase two of the state’s reopening plan, effective June 1-30.

    Nevada

    Under an April 28 announcement (PDF) by the governor, the Nevada Hospital Association moved toward resuming elective procedures. The announcement said resumption could include pre-appointment screenings and use of face masks, among other changes. The association approved elective procedures as of May 4.

    New Hampshire

    Under the state’s “state-at-home 2.0” effective May 4-31, health care providers could resume some postponed services. As detailed in separate guidance (PDF), conditions include staff and patient COVID-19 screening and having sufficient protective equipment.

    New Jersey

    As announced May 19, hospitals and ambulatory surgery centers could resume elective procedures May 26, subject to certain guidelines, These included patient mask-wearing, social distancing and employee screening. View the guidelines for ASCs (PDF).

    New Mexico

    • Under an April 30 order (PDF), providers could resume elective procedures, subject to certain guidelines. The order included additional requirements for facilities that provide “ambulatory or inpatient surgery,” including daily reports to the health department on equipment supply and bed capacity.
    • On July 13, the state re-imposed the health order (PDF) that paused elective surgeries. The new closure lasts until July 30.

    New York

    As announced by the governor April 21, providers in counties “without significant risk of COVID-19 surge” could resume elective procedures. April 29 health department guidance (PDF) provided further details of the requirements.

    North Carolina

    Effective May 1, health care providers can resume elective surgeries (PDF). The announcement includes several guidelines for patient screening, protecting employees and use of protective equipment.

    North Dakota

    Under the state’s “smart restart” plan, all businesses must follow certain requirements (PDF) for social distancing and cleanliness. The state does not provide specific guidance for health care providers that reduced services.

    Ohio

    As announced April 27, providers could resume “medically necessary procedures” May 1. Eligible procedures can’t involve an overnight stay and must require minimal use of personal protective equipment.

    Oklahoma

    Under an amended memorandum (PDF), providers can resume “low-acuity surgery” April 30 if they have enough personal protective equipment to do so.

    Oregon

    As announced April 23, providers could resume “nonurgent” procedures May 1, subject to certain requirements. The state issued separate guidelines for hospitals and ambulatory surgical centers (PDF) and medical offices (PDF).

    Pennsylvania

    According to an April 27 health department guidance (PDF) ambulatory surgical centers could resume elective procedures subject to several conditions. Prior to doing so, ASCs “must review the Joint Statement issued by the American College of Surgeons, American Society of Anesthesiologists, Association of perioperative Registered Nurses, and American Hospital Association.” Those treating children should also review additional industry guidance (PDF).

    Rhode Island

    As announced May 7, providers could resume elective surgery May 9. May 8 guidance (PDF) for “ambulatory care settings” provides new recommendations to limit the spread of infection. These include social distancing, screening for COVID-19 symptoms and limiting the number of people who can accompany a patient.

    South Carolina

    The state had not previously limited elective procedures, beyond the provisions of its “stay at home” order. An April 27 executive order (PDF) eases restrictions on retail businesses.

    South Dakota

    Under the state’s “back to normal” plan (PDF), providers could resume elective procedures so long as they have enough “independently sourced” personal protective equipment.

    Tennessee

    The April 8 order (PDF) barring elective procedures ended April 30. An April 24 order (PDF) to start reopening business only eases restrictions on restaurants. 

    Texas

    As announced April 17, providers could resume procedures that “would not deplete the hospital capacity or the personal protective equipment needed to cope with the COVID-19 disaster.” On July 9, Gov. Greg Abbot expanded his ban on elective medical procedures in hospitals to cover more than 100 counties across the state.

    Utah

    An April 21 order (PDF) allowed providers to resume some elective procedures April 22, subject to certain requirements. The Utah Hospital Association issued a more-detailed guide on how to safely resume elective surgeries (PDF).

    Vermont

    As announced May 4, providers could resume some elective procedures, subject to several requirements. These include screening, patient use of face masks, social distancing in waiting rooms and limits on who can attend an appointment.

    Virginia

    On April 29, the governor announced that elective surgeries can resume beginning May 1.

    Washington

    Effective May 18 (PDF), providers could resume elective procedures, subject to certain criteria. An April 29 interpretive statement (PDF) included several criteria for assessing harm to patients with delayed procedures, as well as requirements for proceeding with treatment.

    Washington, D.C.

    Under phase one of the mayor’s reopening plan, providers could resume elective surgery (PDF) May 29. Requirements included patient screening and face-mask use and several requirements for facilities, including to ensure all water systems had been flushed of stagnant water.

    West Virginia

    Under an April 20 order (PDF), hospitals and ambulatory surgical centers could resume elective procedures, after approval by the state’s Office of Health Facility Licensure and Certification. Contact the office for details on how to apply for resumption of elective procedures.

    Wisconsin

    Health care systems voluntarily canceled or postponed elective surgeries. but news reports indicate they’re beginning to resume these. Under the order in effect through May 26, businesses must follow certain guidelines for reopening (PDF). Per the state’s “bounce back” plan (PDF), these include several infection-control measures.

    Wyoming

    Under April 24 guidance (PDF), providers could resume elective procedures, subject to certain guidelines. As with many other states, providers cannot use state-provided protective equipment for such procedures.

    Further Resources

    On March 18, the Academy recommended that ophthalmologists temporarily cease all but urgent or emergent procedures.

    View all Academy resources on the pandemic at aao.org/coronavirus.

    States Reopening Map