COVID-19 Resources

End of the COVID-19 Emergency:
What Physicians Need to Know


The Governor of California issued multiple executive orders authorizing waivers of law to allow the state to respond to the COVID-19 pandemic. This included delaying continuing medical education requirements for physician licensing, allowing physicians from out of state and retired physicians to practice in California without a current California license, and health care facility licensing flexibilities that allowed the health care system to flex capacity. Most of the waivers issued under the public health emergency were already allowed to expire.

Physician Licensing

Physicians licensed out-of-state who received authorization from the Emergency Medical Services Authority (EMSA) to practice in California without a license issued by the Medical Board of California are no longer be permitted to practice pursuant to that authorization after February 28, 2023. Physicians who have not received California licensure and wish to continue practicing, should check the board’s website for information on how to obtain licensure in California and/or temporary licensure options.

Medical Board Waivers

The following waivers did not have an expiration date and will terminate when the state’s declaration of emergency ends on February 28, 2023:

  • DCA-21-144: Allows medical residents to administer COVID-19 vaccine outside training program
  • DCA-21-140: Allows health care providers with expired, inactive or lapsed licenses to order and administer COVID-19 vaccines
  • DCA-21-139: Allows health care students to administer COVID-19 vaccines
  • DCA-21-138: Waives physician specific order requirement for medical assistants to administer COVID-19 vaccines
  • DCA-21-137: Allows licensed midwives, physician assistants, respiratory care practitioners, and veterinarians to order and administer COVID-19 vaccines

Additional waivers put in place for Medical Board of California licensees, issued by the Department of Consumer Affairs (DCA) and extended throughout COVID-19, were already allowed to expire on January 31, 2023, with no extension. For a list of DCA-issued waivers that already expired, please see the medical board’s COVID-19 Updates webpage.

Health Facilities Waivers

The California Department of Public Health (CDPH) recently issued an All Facilities Letter (AFL) that lists the remaining waivers that will be lifted when the public health emergency expires on February 28: 

  • AFL 20-26.13: Suspension of Regulatory Enforcement of Hospital Requirements. This waiver temporarily lifted licensing requirements allowing hospitals to reconfigure physical space and classification of beds as needed to accommodate observed or predicted patient surge.
  • AFL 20-30.9Primary Care Clinic and Mobile Health Care Unit Requirements. This waiver suspended certain licensing requirements and regulatory enforcement for clinics conducting COVID-19 treatment, testing and/or vaccinations.
  • AFL 20-35.8Certified Nurse Assistants. This waiver suspended professional certification and renewal requirements for certified nurse assistants through the end of the state of emergency. 
  • AFL 20-40.5: Nurse Assistant Training Programs. This waiver suspended certain regulatory requirements for nurse assistant training programs and nursing facilities that provide instruction and training to nurse assistants seeking to become certified nurse assistants. 
  • AFL 20-49.6Home Health Aides. This waiver suspended various professional certification and regulatory enforcement requirements for home health aides. 
  • AFL 20-57.5: Home Health Aide Training Programs. This waiver suspended various professional certification requirements and accompanying regulations with respect to home health aides.
  • AFL 21-36.3: Skilled-Nursing Facility Requirements. This waiver suspended regulatory enforcement of space conversion requirements. 

Facilities must be in compliance with the statutory and regulatory requirements by March 1. 

Physicians as Employers

Nearly all health care industry employers are covered by the Aerosol Transmissible Disease (ATD) Standard established by the California Division of Occupational Safety and Health (Cal/OSHA) in 2009. The ATD standard aims to establish a comprehensive approach to prevent and control workplace transmission of disease. The ATD standard applies to medical offices with some exemptions for medical specialty practices where:

  • Aerosol-generating procedures are not performed on ATD cases or suspected cases.
  • The employer’s Injury and Illness Prevention Program includes written screening procedures to identify potential ATD cases and refer them to an appropriate medical provider for further evaluation.
  • The employer trains their employees on the screening procedure.

For more information on the ATD Standard requirements, see CMA Health Law Library document CMA Health Law Library document #6302.

Cal-OSHA adopted non-emergency COVID-19 regulations that became effective February 3, 2023. The regulations will remain in effect for two years and apply to most employers who are not required to meet the Aerosol Transmissible Disease (ATD) standard. The non-emergency COVID-19 regulations apply to those practices that are exempted from ATD standard and cover issues including prevention, testing and recording keeping. Cal/OSHA has created multiple tools to help employers understand the regulatory requirements.

Quarantine and Isolation

CDPH is changing, effective March 13, 2023, the isolation time required after a person tests positive for COVID-19. Individuals who have tested positive for COVID-19 should continue to isolate for 5 days, but may leave isolation after 5 days, if they are feeling well, symptoms are improving and are fever-free for 24 hours. In addition, persons may also remove their mask after ending isolation sooner than the 10 days recommended if they have two sequential negative tests at least one day apart.

This guidance does not apply to workers in general acute care hospitals, acute psychiatric hospitals or skilled nursing facilities. All Facilities Letter (AFL) 21-08.9 applies to workers in these facilities. This AFL establishes work restrictions for health care workers with COVID-19 infection based upon “routine” and “critical staffing shortage” designations. CDPH notes that health care personnel not covered by AFL 21-08.9 may follow the guidance therein.

CDPH also advises that employers consult the appropriate Cal/OSHA regulations, either the Aerosol Transmissible Disease (ATD) Standard or the COVID-19 Non-Emergency Regulations for any additional applicable requirements.

Mask Requirements in Health Care Settings

On Friday, March 4, CDPH announced that the requirement for masking in health care settings will end effective April 3, 2023. The timeline is intended to allow local jurisdictions and individual health care facilities to develop and implement their own plans to meet local conditions. CDPH advises health care facilities and health care settings to develop and implement their own specific plans based upon their community, patient population, and other facility considerations incorporating CDPH and CDC recommendations. Note that the ADT Standard (see above) requires development of written source control procedures, which may incorporate a setting’s masking requirements.

Additionally, physicians should check their local health jurisdictions for any local requirements.

Vaccination Requirements for Health Care Workers

Similar to masking requirements, CDPH noted that federal rules continue to apply to many settings. The federal requirements apply to CMS-certified providers and suppliers. The Centers for Medicare and Medicaid Services has specific guidance for the following providers: 

  • Long Term Care and Skilled Nursing Facilities
  • Ambulatory Surgical Centers
  • Hospice
  • Hospitals
  • Psychiatric Residential Treatment
  • Intermediate Care Facilities for Individuals with Intellectual Disabilities
  • Home Health
  • Comprehensive Outpatient Rehabilitation
  • Critical Access
  • Outpatient Physical Therapy
  • Community Mental Health
  • Home Infusion
  • Rural Health/Federally Qualified Health
  • End State Renal Disease Facility

Additionally, physicians should check their local health jurisdictions for any local requirements.

Health Coverage for COVID-19 Vaccination and Treatments

Even after the state and federal emergencies end, Californians will continue to be able to access COVID-19 vaccines, testing and therapeutics with no out-of-pocket costs, thanks to legislation the California Medical Association (CMA) worked to pass. Senate Bill 510, sponsored by CMA, requires insurers in California to keep covering COVID-19 testing and vaccination after the public health emergency ends.

Additionally, another California law, SB 1473, requires health plans and insurers to continue covering the costs of COVID-19 therapeutic treatments like Paxlovid for six months after the federal emergency ends. The bill also allows insured people to seek reimbursement for at-home COVID-19 tests purchased in stores. However, six months after the end of the federal public health emergency, Californians will need to get COVID-19 tests through in-network providers to avoid charges.


Even before the COVID-19 pandemic, which brought seismic changes in telehealth, CMA advocated for the expansion of telehealth to make health care more easily accessible to patients. Through CMA’s advocacy, certain telehealth flexibilities offered at the start of the pandemic have been made permanent and, in many instances, virtual services will be paid at parity with in-person visits. Telehealth in the Medicare program is not affected by the end of the state of emergency. Congress has agreed that all telehealth flexibilities in Medicare will extend until December 31, 2024.


Specifically, within the Medi-Cal system, the State of California has agreed to permanent telehealth payment parity, including audio-only (telephone) visits. This will require the use of the audio-only modifier 93, which the American Medical Association established last year, and the associated CPT Appendix T, which defines and creates codes for real-time interactive audio technology.

For more information about telehealth and the Medi-Cal program, please see the DHCS Telehealth FAQ.

Commercial Payors

Because of legislation sponsored by CMA, even after California’s state of emergency ends, telehealth visits for patients with commercial insurance will in most instances be paid at the same rate as in-person care.

  • In 2019, CMA sponsored AB 744, which required commercial payor contracts issued or renewed after Jan. 1, 2021, to pay telehealth visits at parity with in-person office visits.
  • In 2021, CMA sponsored AB 457, which expanded AB 744 by ensuring telehealth parity is applied to all commercial contracts. (Note: this measure did not apply to delegated groups.)

Medi-Cal Provider Enrollment

Effective March 29, 2023, DHCS is discontinuing the provider enrollment flexibilities authorized by the Section 1135 waiver. Providers temporarily and provisionally enrolled as Medi-Cal providers under the amended enrollment requirements who wish to remain enrolled in fee-for-service Medi-Cal after that date must submit a complete application for their provider type and meet all program requirements if they have not already done so.

Providers will have 90 days from the end of the waiver period on March 29, 2023, to submit an application for enrollment via the Provider Application and Validation for Enrollment (PAVE) portal. Providers who have not submitted an application by June 27, 2023, will have their temporary enrollment deactivated effective June 28, 2023.

For more information, click here.


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