Industry 04 of 27

Home Care, Nursing and Senior Living

The industry operated for the whole claim period inside a federal regulatory layer that no other industry carries, and that layer is force of law.

HCin-home visits SNskilled nursing and assessments RSresidential care VSvisitation INintake and referrals ICinfection control and staff…TRtransport of aides DNdining and activities HRhiring, screening, training and…OFoffice, administration and…WFworkforce availability CBpatients and payers

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In plain terms: if you run a home health or home care agency, a hospice, a nursing home, an assisted living community or an adult day center, the orders of 2020 and 2021 did not close your doors. They did what the IRS letters leave out. From March 13, 2020 a federal directive barred every visitor from every certified nursing home and cancelled communal dining and every group activity. From May 2020 the States began ordering universal testing of your residents and your staff, and from September 2, 2020 a federal condition of participation required it on a schedule set by your county's positivity rate, with untested workers kept out of the building. Hospitals were ordered to stop the elective procedures that generate your referrals, and New York would not let a hospital discharge to a nursing home without a negative test. Your aides worked under screening at the door of every home, under a federal occupational standard from June 21, 2021, and, in fifteen States and cities, under vaccination-or-testing orders issued between July 26 and September 28, 2021 that named home care agencies and home health aides in terms. Those orders reached all twelve functions of your business: the visit, the assessment, the admission, the visitor, the referral, infection control, transport, dining, hiring, the office, the workforce and the payer.

This page sets out those orders layer by layer, quarter by quarter and function by function, with a link to the instrument behind each one, and answers the fourteen sentences the IRS letters use. The quarter the letters most often dispute is the third quarter of 2021, and the record answers it: on every day of that quarter, in every State, a federal testing condition, a federal visitation condition and a federal occupational standard were in force on this industry.

Partial suspension, element by element

Every analysis on this site asks the same five questions in the same order. Here they are asked of Home Care, Nursing and Senior Living, from the industry's own record.

The order: issuer, instrument, date, exhibit.The Library holds 70 instruments from this industry's own regulators and sector authorities and 36 organizer notices. The earliest is Centers for Medicare & Medicaid Services (section 1135 waiver authority), COVID-19 Emergency Declaration Blanket Waivers for Health Care Providers (LTC facilities, HHAs, hospices, ICF/IIDs) (Mar. 30, 2020) (Ex. SEC-04-015). The fifty-State regime table below names the State orders that reached its premises, State by State, each with its exhibit; the federal layer and the standing duties sit behind them on every day of the six quarters.
The function of the business it reached.The orders named the functions of the business in terms. Three of this industry's 12 function codes: HCin-home visitsSNskilled nursing and assessmentsRSresidential care. The full key follows this panel, and Function by function reads the orders against each code.
The change it compelled: the operative words.The operative words of COVID-19 Emergency Declaration Blanket Waivers for Health Care Providers (LTC facilities, HHAs, hospices, ICF/IIDs) (Ex. SEC-04-015): “Home Health Agencies:... CMS is waiving the requirements... at 42 CFR 484.55(a)(2) and 484.55(b)(3)... to allow HHAs to perform initial assessments and determine patients' homebound status remotely or by record review... 484.80(h)... waiving the requirements... for a nurse to conduct an onsite visit…” Each record page quotes the operative words in full, with the enforcement provision beside them.
The quarter: in force on which days.Every instrument carries the quarters it was in force. This industry's record runs across all six: 2020 Q242 2020 Q340 2020 Q424 2021 Q124 2021 Q225 2021 Q350 (the count is this industry's own instruments carrying the quarter). The six quarters sets out what was in force in each, and the third quarter of 2021 is listed instrument by instrument below.
The statute's answer.A partial suspension is a temporary delay, interruption or termination of a portion of the business's operations; the order need only be the but-for cause of it; and nothing in the Suspension Clause asks whether the business was essential, stayed open, could telework or served customers who were themselves under orders (Tri-State Memorial Hospital v. United States). The test and the method are stated once, for every industry, at Partial suspension, element by element.

The same five steps run through the report the site builds for your own State, metro and quarters.

Function codes

The analysis describes the business as twelve functions, each with a two-letter code that every page of this set uses without variation. An order “reached” a function when its operative words told the business what that part of it could do, when, where, for how many and on what conditions.

Code	Function of the business
HC	in-home visits
SN	skilled nursing and assessments
RS	residential care (admissions, testing, cohorting)
VS	visitation
IN	intake and referrals (hospital and facility discharges)
IC	infection control and staff mandates
TR	transport of aides
DN	dining and activities
HR	hiring, screening, training and credentialing
OF	office, administration and telework
WF	workforce availability
CB	patients and payers

The fifty-State regime table

One row per State and the District of Columbia. Every row sits on the federal floor, which is force of law in every State through the Medicare and Medicaid conditions of participation: QSO-20-14-NH REVISED (Mar. 13, 2020) (visitation restricted to compassionate care; communal dining and group activities cancelled; universal screening) (Ex. SEC-04-001); QSO-20-30-NH (May 18, 2020) reopening phases; 42 C.F.R. 483.80(g) (May 8, 2020) and 483.80(h) (Sept. 2, 2020; QSO-20-38-NH Aug. 26, 2020; REVISED 09/10/2021) (Ex. SEC-04-004 to -007, -073); QSO-20-39-NH (Sept. 17, 2020; REVISED 03/10/2021 and 04/27/2021; REVISED 11/12/2021 post-period) (Ex. SEC-04-002, -003, -077); 483.80(d)(3) (May 21, 2021) (Ex. SEC-04-008, -009); 29 C.F.R. 1910.502 (June 21, 2021; compliance July 6 and 21, 2021) (Ex. SEC-04-014, -023); the section 1135 blanket waivers (Ex. SEC-04-015, -025); CMS-1744-IFC (Ex. SEC-04-017); and the State's Appendix K amendments (every State and D.C. obtained Appendix K approvals; KFF Aug. 26, 2020 counts; Pennsylvania exemplar Ex. SEC-04-078). 'AARP status' entries are the AARP State-by-State survey as updated Sept. 11, 2020 and Dec. 16, 2020 (Wayback captures of Sept. 16, 2020 and Mar. 3, 2021), grade verified_secondary. 'HCW mandate' means a State instrument binding private health care or long-term care employers in Q3 2021; 'none statewide' means the federal layer alone applied and the CMS Aug. 18 and Sept. 9, 2021 announcements were the operative federal vaccination signals. Function codes reached by the row's instruments follow the industry set (HC SN RS VS IN IC TR DN HR OF WF CB). Exhibit identifiers are the Library's; instruments without an identifier are cited by name and date.

One row per State and the District. The State name opens the State's own page; every exhibit ID opens the instrument. Sort by State from the column head, or type to find a State.

State	Code	LTC visitation, 2020	AARP status, Sept. 11, 2020	AARP status, Dec. 16, 2020	Testing order	Health-care worker mandate, 2021	Home-care directive	Q3 2021	Functions	Exhibits	Grade
AlabamaAL	AL	Federal floor QSO-20-14-NH Mar. 13, 2020.	Compassionate care visits only.	Facilities meeting requirements may schedule visits; masks and distancing; one visitor at a time.	483.80(h) federal testing from Sept. 2, 2020; no State testing order identified.	None statewide; federal layer only.	None identified; general orders (State file).	OSHA ETS; 483.80(g),(h),(d)(3); QSO-20-39-NH REVISED 04/27/2021.	VS; DN; RS; IN; IC; CB	SEC-04-001; SEC-04-003; SEC-04-004; SEC-04-014	Confirmed from a secondary source (AARP status).
AlaskaAK	AK	Reopening guidelines for LTC facilities released end of June 2020 (AARP).	Compassionate care only; outdoor visits permitted for facilities meeting two-week requirements.	Compassionate care only (unchanged).	483.80(h).	None statewide.	None identified.	Federal layer.	VS; DN; RS; IC; CB	SEC-04-001; SEC-04-003; SEC-04-014	Confirmed from a secondary source (AARP).
ArizonaAZ	AZ	County-benchmark reopening summer 2020.	Outdoor visits in counties meeting benchmarks; indoor limited to compassionate care and minimal-spread counties; indoor visits for visitors with negative test, mask and self-isolation attestation.	Unchanged.	483.80(h).	None statewide (Arizona barred local vaccination mandates by statute in 2021; State file).	None identified.	Federal layer.	VS; RS; IC; CB	SEC-04-001; SEC-04-003; SEC-04-014	Confirmed from a secondary source (AARP).
ArkansasAR	AR		Facilities meeting requirements may schedule visits; two visitors per resident; masks; outdoor preferred.	Unchanged.	483.80(h).	None statewide (Act 977 of 2021 barred State and local vaccination mandates; State file).	None identified.	Federal layer.	VS; RS; IC; CB	SEC-04-001; SEC-04-003; SEC-04-014	Confirmed from a secondary source (AARP).
CaliforniaCA	CA	CDPH AFL 20-22 (Mar. 13, 2020) SNF visitation restrictions, revised through AFL 20-22.9 (Aug. 12, 2021) (Ex. SEC-04-068).	Facilities meeting requirements may schedule visits; one visitor per resident indoors; masks; outdoor encouraged.	Unchanged (CDPH guidelines).	AFL 20-53 (June 9, 2020) SNF testing and mitigation plans, revised through AFL 20-53.6 (Dec. 27, 2021) (Ex. SEC-04-069); 483.80(h).	SPHO Order July 26, 2021 (effective Aug. 9; full compliance Aug. 23, 2021): unvaccinated workers in hospitals, SNFs, adult and senior care facilities, hospice facilities and other listed settings tested weekly or twice weekly and masked (Ex. SEC-04-036); SPHO Order Aug. 5, 2021: workers in SNFs, ICFs, ADHCs, PACE, hospice facilities and other listed facilities fully vaccinated by Sept. 30, 2021 (Ex. SEC-04-035); SPHO Order Sept. 28, 2021: workers in CDSS-licensed adult and senior care facilities, in-home direct care workers including registered home care aides and certified home health aides, IHSS and WPCS providers, and hospice workers in the home fully vaccinated by Nov. 30, 2021 (Ex. SEC-04-037). Cal/OSHA ETS (State file).	Sept. 28, 2021 order (above) is the direct home-care instrument.	All three SPHO orders; AFL 20-22.9; Cal/OSHA ETS readopted June 17, 2021; federal layer.	HC; SN; RS; VS; IN; IC; HR; WF; CB	SEC-04-035; SEC-04-036; SEC-04-037; SEC-04-068; SEC-04-069	Primary source read
ColoradoCO	CO		Facilities meeting requirements may schedule visits; outdoor encouraged; masks.	Unchanged.	483.80(h).	Governor's Aug. 17, 2021 letter urging the State Board of Health to adopt an emergency rule requiring vaccination of personnel in licensed health care facilities; State 24/7 facility personnel first dose by Sept. 30, 2021 as a condition of employment (Ex. SEC-04-056, verified_primary for the release).		Governor's Aug. 17 letter; Denver Public Health Order of Aug. 2, 2021 requiring vaccination of workers in high-risk settings including nursing homes and home care by Sept. 30, 2021 (metro DEN file; verified_secondary here).	IC; HR; WF; RS; HC	SEC-04-056	Primary source read (release).
ConnecticutCT	CT	Governor's EO 7 series (State file).	Facilities meeting requirements may schedule visits; outdoor encouraged; number set by facility (DPH guidelines).	Unchanged.	483.80(h).	EO 13B (Aug. 6, 2021): by Sept. 7, 2021 long-term care facilities (nursing homes, residential care homes, assisted living services agencies, managed residential communities and others defined) shall require staff vaccination, subject to civil penalty under Conn. Gen. Stat. 19a-525 (Ex. SEC-04-031); EO 13F (Sept. 3, 2021) repealed and superseded 13B and moved the deadline to Sept. 27, 2021 with exemption procedures (Ex. SEC-04-051). EO 13D (Aug. 19, 2021) and EO 13G (Sept. 10, 2021): State employees, school staff and child care staff (Ex. SEC-04-052; context).	None statewide beyond the assisted living services agency coverage in 13B/13F.	EO 13B, 13F; federal layer.	IC; HR; WF; RS; VS	SEC-04-031; SEC-04-051; SEC-04-052	Primary source read (13B, 13D, 13F).
DelawareDE	DE		Facilities may submit outdoor and indoor visitation plans to DHSS; masks; indoor visits limited to two guests per resident.	Unchanged.	483.80(h).		None identified.	DHSS vaccination-or-testing requirement (from Sept. 30, 2021); federal layer.	IC; HR; WF; RS	SEC-04-055	Primary source read (release).
District of ColumbiaDC	DC		Outdoor visits at facilities meeting requirements; indoor limited to compassionate care (Mayor Bowser's phase 2 guidelines).	Unchanged.	483.80(h).	DC Health requirement announced Aug. 16, 2021: all licensed, certified and registered health professionals, EMS providers and unlicensed health care workers including personal care aides vaccinated by Sept. 30, 2021, with medical and religious exemptions and an interim testing alternative (NBC Washington, Aug. 16, 2021; verified_secondary). Mayor's Order 2021-099 (Aug. 10, 2021): vaccination certification requirement for District Government employees, contractors, interns and grantees (Ex. SEC-04-059; scanned).	The Aug. 16, 2021 requirement reaches personal care aides (secondary).	DC Health requirement (Sept. 30, 2021 deadline); Mayor's Order 2021-099; federal layer.	IC; HR; WF; HC	SEC-04-059	Primary source read (MO 2021-099); Confirmed from a secondary source (HCW requirement)
FloridaFL	FL	DEM Emergency Order 20-006 (Mar. 15, 2020) prohibiting visitation to nursing homes, assisted living facilities, adult family-care homes, long-term care hospitals, ICF/DDs and group homes (Ex. SEC-04-040, scanned); extended by DEM Orders 20-007 (May 18, 2020) (Ex. SEC-04-062) and 20-008 (July 13, 2020) (Ex. SEC-04-072, scanned); DEM Order 20-009 (Sept. 1, 2020) revised the restrictions to allow essential caregivers and compassionate care visitors and general visitation under conditions (Ex. SEC-04-041).	Facilities meeting requirements may schedule visits; two visitors per resident; masks.	October 2020: outdoor visits allowed to continue at facilities with cases; visitor-number limits relaxed.	483.80(h).	None statewide (Florida barred vaccination-proof requirements by statute; State file).	None identified.	Federal layer; Florida's Sept. 2021 restrictions on employer mandates (State file).	VS; DN; RS; IN; IC; CB	SEC-04-040; SEC-04-041; SEC-04-062; SEC-04-072	Primary source read (DEM 20-006 to 20-009).
GeorgiaGA	GA	Executive Order 04.08.20.03 (Apr. 8, 2020), 'Ensuring the safety of employees and residents of nursing homes and long-term care facilities' (Ex. SEC-04-060, scanned); Governor's LTC provisions carried in the 'Empowering a Healthy Georgia' orders through 2021 (State file).	Compassionate care only.	Mid-September 2020 plan: outdoor visits in low-transmission counties after 28 outbreak-free days; indoor visits after benchmarks.	483.80(h).	None statewide.	None identified.	Federal layer; Governor's LTC executive order provisions (State file).	VS; DN; RS; IC; HR; CB	SEC-04-060	Primary source read (EO 04.08.20.03 document); Confirmed from a secondary source (Sept. 2020 plan)
HawaiiHI	HI	DOH directive discouraging all LTC visits and limiting to one adult visitor per day; compassionate care only (AARP).	Compassionate care only.	Compassionate care only; November 2020 grants for outdoor visit equipment.	483.80(h).	State employees only (EO 21-05, Aug. 5, 2021; State file); no private HCW mandate.	None identified.	Federal layer; Hawaii Safe Travels quarantine on travel nurses and aides (ECO-C).	VS; RS; IC; TR; CB	SEC-04-001; SEC-04-003	Confirmed from a secondary source (AARP).
IdahoID	ID	Idaho Rebounds LTC guidance.	Final reopening stage: visitors allowed to return; hygiene and distancing advised.	Unchanged.	483.80(h).	None statewide.	None identified.	Federal layer; Idaho crisis standards of care (Sept. 2021; State file).	VS; RS; IC	SEC-04-001; SEC-04-003	Confirmed from a secondary source (AARP).
IllinoisIL	IL	Governor's disaster proclamations (State file).	Outdoor visits by schedule; indoor compassionate care only; two visitors per resident.	Unchanged (IDPH outdoor visitation guidance).	483.80(h).	EO 2021-20 (Aug. 26, 2021): Health Care Workers at Health Care Facilities (defined to include hospices, long-term care facilities, assisted living, supportive living and adult day care) vaccinated or tested at least weekly; statewide indoor mask requirement from Aug. 30, 2021 (Ex. SEC-04-033); EO 2021-22 (Sept. 3, 2021): first dose by Sept. 19, 2021, second within 30 days; unvaccinated tested weekly (Ex. SEC-04-034).	Health Care Facility definition ('any institution, building, or agency... used... to provide health services... or nursing') reaches home health agencies by its terms; not separately listed.	EO 2021-20, 2021-22; federal layer.	IC; HR; WF; RS; HC; SN	SEC-04-033; SEC-04-034	Primary source read (2021 EOs).
IndianaIN	IN	ISDH visitation restrictions Mar. 2020.	Facilities meeting requirements may schedule visits; outdoor encouraged; masks; number set by facility.	Unchanged.	483.80(h).	None statewide.	None identified.	Federal layer.	VS; RS; IC	SEC-04-001; SEC-04-003	Confirmed from a secondary source (AARP).
IowaIA	IA		Facilities meeting requirements may schedule visits; outdoor encouraged; masks.	Unchanged (IDPH LTC guidance).	483.80(h).	None statewide.	None identified.	Federal layer.	VS; RS; IC	SEC-04-001; SEC-04-003	Confirmed from a secondary source (AARP).
KansasKS	KS		Facilities meeting requirements may schedule visits; KDADS recommends outdoor visits where indoor requirements unmet; masks.	Unchanged.	483.80(h).	None statewide.	None identified.	Federal layer.	VS; RS; IC	SEC-04-001; SEC-04-003	Confirmed from a secondary source (AARP).
KentuckyKY	KY	CHFS directive restricting LTC visitation Mar. 2020.	Facilities meeting requirements may schedule visits; masks; compassionate care continues.	Indoor visits beginning Nov. 16, 2020 (CHFS guidance).	483.80(h).	None statewide.	None identified.	Federal layer; EO 2021-585 school masking (WF; ECO-B).	VS; RS; IC; WF	SEC-04-001; SEC-04-003	Confirmed from a secondary source (AARP).
LouisianaLA	LA		Compassionate care only (LDH nursing home toolkit).	LDH deferred to CMS QSO-20-39-NH: outdoor and indoor visits at facilities meeting requirements without outbreak.	483.80(h).	None statewide.	None identified.	Federal layer; Louisiana's Aug. 4, 2021 indoor mask order (State file).	VS; RS; IC; DN	SEC-04-001; SEC-04-003	Confirmed from a secondary source (AARP).
MaineME	ME		Outdoor visits by schedule; indoor compassionate care only (DHHS guidelines).	Unchanged.	483.80(h).	Maine CDC emergency rule 10-144 CMR ch. 264 (adopted Aug. 12, 2021): employees of licensed health care facilities (hospitals, nursing facilities, home health agencies and others) vaccinated by Oct. 1, 2021; enforcement from Oct. 29, 2021; described in Does 1-6 v. Mills (1st Cir. Oct. 19, 2021) (Ex. SEC-04-066; verified_secondary for the rule text).	Home health agencies are covered facilities under the emergency rule (per the First Circuit's description).	Maine CDC emergency rule; federal layer.	IC; HR; WF; HC; SN; RS	SEC-04-066	Confirmed from a secondary source (rule).
MarylandMD	MD		Outdoor visits by schedule; indoor compassionate care only.	Unchanged.	483.80(h).	Governor's Aug. 18, 2021 announcement: staff of the State's 227 nursing homes and all hospitals must receive a first dose by Sept. 1, 2021 or undergo regular testing, implemented by MDH order (WBOC report Aug. 18, 2021, Ex. SEC-04-065; verified_secondary).	None identified.	Aug. 18, 2021 requirement; federal layer.	IC; HR; WF; RS	SEC-04-065	Confirmed from a secondary source (press).
MassachusettsMA	MA	Massachusetts was the first State to resume visits (June 2020) (AARP).	Facilities meeting requirements may schedule visits; outdoor encouraged; masks.	Unchanged.	483.80(h).	Aug. 4, 2021 announcement by Governor Baker: all nursing home staff must be vaccinated; enforcement begins Oct. 10, 2021 (The Hill, Aug. 4, 2021, read from Wayback capture; verified_secondary; no exhibit).	None retrieved.	Aug. 4, 2021 nursing home staff requirement; DPH health-care masking (May 29, 2021 order; State file); federal layer.	IC; HR; WF; RS		Confirmed from a secondary source (press).
MichiganMI	MI		Outdoor visits by schedule; indoor compassionate care only (MDHHS guidance).	Unchanged.	483.80(h).	None statewide.	None identified.	Federal layer.	VS; RS; IC; DN	SEC-04-001; SEC-04-003	Confirmed from a secondary source (AARP).
MinnesotaMN	MN		Outdoor visits by schedule; indoor compassionate care only; masks 'as tolerated' (MDH guidelines).	Unchanged.	483.80(h).	State employees only (Aug. 2021); no private HCW mandate.	None identified.	Federal layer.	VS; RS; IC	SEC-04-001; SEC-04-003	Confirmed from a secondary source (AARP).
MississippiMS	MS		Outdoor visits by schedule; indoor compassionate care only; two visitors per resident.	Unchanged.	483.80(h).	None statewide.	None identified.	Federal layer; State Health Officer's Aug. 2021 LTC visitation and masking orders (State file).	VS; RS; IC	SEC-04-001; SEC-04-003	Confirmed from a secondary source (AARP).
MissouriMO	MO	DHSS visitation restrictions Mar. 2020.	Outdoor visits by schedule; indoor compassionate care only (DHSS reopening guidance).	Unchanged.	483.80(h).	None statewide.	None identified.	Federal layer.	VS; RS; IC	SEC-04-001; SEC-04-003	Confirmed from a secondary source (AARP).
MontanaMT	MT		Facilities meeting requirements may ease restrictions and schedule visits; screening, distancing, sanitation protocols.	Unchanged.	483.80(h).	None statewide (HB 702 of 2021 barred vaccination-status discrimination; State file).	None identified.	Federal layer.	VS; RS; IC	SEC-04-001; SEC-04-003	Confirmed from a secondary source (AARP).
NebraskaNE	NE	Visitation tied to local health district phase.	Visitation depends on local health district phase and facility requirements; outdoor encouraged; masks.	Unchanged (DHHS LTC guidance).	483.80(h).	None statewide.	None identified.	Federal layer.	VS; RS; IC	SEC-04-001; SEC-04-003	Confirmed from a secondary source (AARP).
NevadaNV	NV		Compassionate care only.	Outdoor visits at facilities meeting requirements.	483.80(h).	State employees only (Board of Health regulation for higher-education and State workers); no private HCW mandate.	None identified.	Federal layer; Emergency Directive 047 (July 27, 2021) indoor masks (State file).	VS; RS; IC	SEC-04-001; SEC-04-003	Confirmed from a secondary source (AARP).
New HampshireNH	NH		Outdoor visits by appointment; indoor limited to compassionate care and residents unable to go outdoors; two visitors per resident (DPHS guidance).	Unchanged.	483.80(h).	None statewide.	None identified.	Federal layer.	VS; RS; IC	SEC-04-001; SEC-04-003	Confirmed from a secondary source (AARP).
New JerseyNJ	NJ	Executive Directive 20-026 (Aug. 20, 2020) phased resumption of services with Phase 0 maximum restrictions for outbreak facilities (Ex. SEC-04-043); Executive Directive 21-012 (later revision of Dec. 22, 2022 saved) recites the sequence (Ex. SEC-04-044).	Outdoor visits by schedule; indoor compassionate care only; two visitors per resident.	Unchanged.	Executive Directive 20-013 (May 12, 2020; revised May 20, 2020): outbreak plans and baseline molecular testing of all staff and residents with retesting in 3-7 days and continued staff testing (Ex. SEC-04-042); 483.80(h).	EO 252 (Aug. 6, 2021): covered health care facilities (including 'licensed home health agencies and registered health care service firms operating within the State') and high-risk congregate settings (long-term care facilities, assisted living and others) must maintain a policy requiring covered workers to provide proof of vaccination or submit to testing one to two times weekly, effective Sept. 7, 2021 (Ex. SEC-04-030).	DOH memorandum to home health agency and hospice administrators (Mar. 13, 2020) waiving geographic and other operational limits (Ex. SEC-04-063); DOH blanket waiver of N.J.A.C. 8:42 home health licensing standards more stringent than CMS waivers (Apr. 24, 2020) (Ex. SEC-04-064); EO 242 (May 24, 2021) para. 13 kept masking and distancing in 'home health care settings' (State file).	EO 252 (from Sept. 7); ED 20-026 phases; EO 242 health-care masking; federal layer.	HC; SN; RS; VS; IN; IC; HR; WF; CB	SEC-04-030; SEC-04-042; SEC-04-043; SEC-04-044; SEC-04-063; SEC-04-064	Primary source read
New MexicoNM	NM	DOH public health orders restricting LTC visitation Mar. 2020.	Outdoor visits by schedule; indoor compassionate care only; only facilities in certain counties may reopen (DOH LTC visitation plan).	Unchanged.	483.80(h).	State employees vaccinate-or-test from Aug. 2, 2021 (KUNM, July 30, 2021).	None identified.	Federal layer; New Mexico's Aug. 2021 indoor mask order (State file).	IC; HR; WF; RS; VS		Confirmed from a secondary source (State-employee policy)
New YorkNY	NY	DOH visitation guidance of Sept. 15, 2020 keyed to 14 days without cases; county-based restrictions in high-spread areas (AARP Dec. 2020).	Limited scheduled visits; outdoor encouraged; two visitors at a time, one adult.	Visits restricted in counties with high community spread.	EO 202.30 (May 10, 2020): operators and administrators of all nursing homes and adult care facilities must test or make arrangements for testing of all personnel for COVID-19 twice per week under a facility plan, and staff who refuse are barred from unrestricted access (Ex. SEC-04-049); 483.80(h).	Governor's Aug. 16, 2021 announcement and DOH Section 16 orders (Ex. SEC-04-057); 10 NYCRR 2.61 (PHHPC emergency regulation effective Aug. 26, 2021): covered entities include hospitals, nursing homes, diagnostic and treatment centers, home care agencies (certified home health agencies, long term home health care programs, licensed home care services agencies and others), hospices and adult care facilities; personnel must receive a first dose by Sept. 27, 2021 (hospitals and nursing homes) and Oct. 7, 2021 (all other covered entities); medical exemption only (Ex. SEC-04-058).	10 NYCRR 2.61 names home care agencies and hospices as covered entities.	2.61 (from Aug. 26); EO 202.30 as continued (State file for its end date); DOH health-care masking; federal layer.	HC; SN; RS; VS; IN; IC; HR; WF; CB	SEC-04-049; SEC-04-057; SEC-04-058	Primary source read (202.30 via Wayback capture of the Governor's page; 2.61; Aug. 16 release).
North CarolinaNC	NC	Executive Order No. 120 (Mar. 23, 2020), 'Additional Limitations on Mass Gatherings, Restrictions on Venues and Long Term Care Facilities' (Ex. SEC-04-039, scanned); NCDHHS Secretarial Orders on LTC visitation (Sept. 2020 onward) (State file).	Outdoor visits by schedule; indoor compassionate care only (NCDHHS guidance).	Unchanged.	483.80(h).	None statewide.	None identified.	Federal layer.	VS; DN; RS; IC; CB	SEC-04-039	Primary source read (EO 120 document); Confirmed from a secondary source (2020 statuses)
North DakotaND	ND		Outdoor visits at all facilities; indoor open to facilities meeting reopening protocols.	Unchanged.	483.80(h).	None statewide.	None identified.	Federal layer.	VS; RS; IC	SEC-04-001; SEC-04-003	Confirmed from a secondary source (AARP).
OhioOH	OH	ODH Director's Order to Limit Access to Ohio's Nursing Homes and Similar Facilities (Mar. 13, 2020), amended through the Sixth Amended Order effective Jan. 7, 2021 (Ex. SEC-04-075); Director's Orders closing older adult day care services and senior centers (Mar. 2020) and reopening them (Aug. 31, 2020); ICF/IID access order and rescission (2021).	Outdoor visits by schedule; indoor compassionate care only (Governor's update).	Scheduled limited visits; two visitors at a time.	Director's Order for the Testing of the Residents and Staff of all Nursing Homes (July 2020) (Ex. SEC-04-074) and of Residential Care Facilities; Amended testing orders of Mar. 19, 2021 and 2021 (Ex. SEC-04-076, scanned; captured July 18, 2021); 483.80(h).	None statewide.	None identified.	Federal layer; Ohio's 2021 amended nursing home testing order.	VS; DN; RS; IN; IC; HR; CB	SEC-04-074; SEC-04-075; SEC-04-076	Primary source read (Sixth Amended Order; 2020 and 2021 testing orders).
OklahomaOK	OK	OSDH phased reopening guidelines.	Facilities meeting requirements may schedule visits; outdoor encouraged; masks.	Unchanged (OSDH phased reopening guidelines).	483.80(h).	None statewide.	None identified.	Federal layer.	VS; RS; IC	SEC-04-001; SEC-04-003	Confirmed from a secondary source (AARP).
OregonOR	OR	Indoor visits suspended in high-spread counties (AARP Dec. 2020).	Outdoor visits by schedule; indoor compassionate care only (OHA LTC testing plan).	Scheduled visits; indoor visits temporarily suspended in certain high-spread counties (OHA reopening guidance).	483.80(h).	OAR 333-019-1010, 'COVID-19 Vaccination Requirement for Healthcare Providers and Healthcare Staff in Healthcare Settings': temporary adoptions filed Aug. 5, Aug. 25 and Sept. 1, 2021 (effective through Jan. 31, 2022), permanent Jan. 31, 2022, repealed June 30, 2023 (Oregon Secretary of State rule record, read Sept. 26, 2026); proof of vaccination on or before Oct. 18, 2021 (OHA FAQ, Ex. SEC-04-067).		OAR 333-019-1010; OAR 333-019-1025 indoor masks (Aug. 13, 2021; State file); federal layer.	IC; HR; WF; HC; SN; RS	SEC-04-067	Confirmed from a secondary source (rule history and FAQ).
PennsylvaniaPA	PA	Department of Health directives restricting nursing home visitation from Mar. 2020 and the phased reopening plan (compassionate care only through Dec. 2020 per AARP); Philadelphia Health Commissioner's Long-Term Care Facility Order (Apr. 8, 2020) (Ex. SEC-04-047, scanned), rescinded Sept. 23, 2020 (Ex. SEC-04-048).	Compassionate care only; phased reopening plan.	Compassionate care only (unchanged).	Order of the Secretary of Health requiring universal testing of SNF residents and staff (June 8, 2020; baseline by July 24, 2020); Order of the Secretary Directing Testing at Long-Term Care Facilities (June 26, 2020): personal care homes, assisted living residences and ICFs to complete universal baseline testing by Aug. 31, 2020 (Ex. SEC-04-050); SNF weekly supply reporting order as amended May 26, 2021 (bundled); 483.80(h).	None statewide on private employers (Commonwealth employees in State health care and congregate facilities from Sept. 7, 2021). Philadelphia Board of Health Emergency Regulation (adopted Aug. 12, 2021; approved, filed and effective Aug. 16, 2021): no Healthcare Institution may employ or use Covered Healthcare Personnel who are not fully vaccinated or exempt from Oct. 15, 2021; documentation, exemption and testing duties from Aug. 16, 2021 (Ex. SEC-04-045); PDPH-HAN-00363A (Aug. 25, 2021): home health aides and home and community based attendants are covered and their employing agencies are Healthcare Institutions (Ex. SEC-04-046).	Governor's May 6, 2020 order suspending 28 Pa. Code 611.5 and 611.55(a)(1) (bundled); Appendix K to the Community HealthChoices and OBRA waivers (Mar. 6, 2020 to May 11, 2023) (Ex. SEC-04-078).	Philadelphia regulation (from Aug. 16); Appendix K; Act 21 and Act 73 of 2021 regulatory suspensions (bundled); federal layer.	HC; SN; RS; VS; IN; IC; HR; WF; CB	SEC-04-045; SEC-04-046; SEC-04-047; SEC-04-048; SEC-04-050; SEC-04-078	Primary source read (Philadelphia regulation and HAN; June 26, 2020 order page; Appendix K); Confirmed from a secondary source (June 8, 2020 order)
Rhode IslandRI	RI	Early Nov. 2020 RIDOH direction limiting all but compassionate-care and federally required visits (AARP).	Scheduled visits for visitors essential to well-being; outdoor encouraged; masks (RIDOH guidance).	All visits limited except compassionate care and federally required visits (early Nov. 2020).	483.80(h).	216-RICR-20-15-8, 'Requirement for Immunization Against COVID-19 for All Workers in Licensed Health Care Facilities and Other Practicing Health Care Providers' (emergency adoption Aug. 17, 2021): by Oct. 1, 2021 all health care workers and health care providers must be vaccinated; from Oct. 1, 2021 'health care facilities shall deny entrance to any health care worker' not vaccinated; facilities include assisted living residences and adult day programs; medical exemption only (Ex. SEC-04-053; the saved text is the Feb. 10, 2022 amended version carrying the same operative section).	Home nursing care and home care providers are licensed health care facilities under R.I. Gen. Laws ch. 23-17 and fall within the regulation's facility definition (regulation text; coverage inference stated as the rule's terms).	216-RICR-20-15-8; federal layer.	IC; HR; WF; RS; HC; SN	SEC-04-053	Primary source read (regulation as amended).
South CarolinaSC	SC		Outdoor visits by schedule; indoor compassionate care only.	Unchanged.	483.80(h).	None statewide.	None identified.	Federal layer.	VS; RS; IC	SEC-04-001; SEC-04-003	Confirmed from a secondary source (AARP).
South DakotaSD	SD		Facilities meeting requirements may schedule visits; outdoor encouraged; indoor dependent on staffing and infection-prevention criteria.	Unchanged.	483.80(h).	None statewide.	None identified.	Federal layer.	VS; RS; IC	SEC-04-001; SEC-04-003	Confirmed from a secondary source (AARP).
TennesseeTN	TN	Governor's visitation guidelines summer 2020.	Scheduled visits at facilities meeting requirements; outdoor encouraged; in-room visits with a negative test within 72 hours (Governor's guidelines).	Unchanged.	483.80(h).	None statewide (Tennessee restricted mandates in Nov. 2021; post-period).	None identified.	Federal layer.	VS; RS; IC	SEC-04-001; SEC-04-003	Confirmed from a secondary source (AARP).
TexasTX	TX	HHSC emergency rules for nursing facilities and assisted living facilities (26 Tex. Admin. Code chs. Governor's Aug. 6, 2020 visitation announcement (AARP).	Outdoor visits by schedule; indoor compassionate care only (Governor's guidance).	Unchanged.	483.80(h).	None statewide (GA-39 and GA-40 barred governmental and, from Oct. 11, 2021, private mandates; State file).		Federal layer; HHSC LTC emergency rules in force.	VS; RS; IC; HC	SEC-04-001; SEC-04-003	Confirmed from a secondary source (AARP).
UtahUT	UT		Compassionate care only.	Outdoor visits by schedule; indoor compassionate care only; two visitors per resident.	483.80(h).	None statewide.	None identified.	Federal layer.	VS; RS; IC	SEC-04-001; SEC-04-003	Confirmed from a secondary source (AARP).
VermontVT	VT		Outdoor visits by schedule; indoor compassionate care only (DAIL guidelines).	Unchanged.	483.80(h).	State employees only; no private HCW mandate.	None identified.	Federal layer.	VS; RS; IC	SEC-04-001; SEC-04-003	Confirmed from a secondary source (AARP).
VirginiaVA	VA	Virginia DOLI emergency temporary standard (July 27, 2020; permanent Jan. 27, 2021) on workplaces including health care (State file).	Outdoor visits by schedule; indoor compassionate care only.	Unchanged.	483.80(h).	State employees only (EO 79, Aug. 5, 2021); no private HCW mandate.	None identified beyond the DOLI standard.	Federal layer; DOLI permanent standard (State file).	VS; RS; IC; HC	SEC-04-001; SEC-04-003	Confirmed from a secondary source (AARP).
WashingtonWA	WA		Compassionate care only; phased LTC plan established Aug. 2020 (DSHS guidance).	Outdoor visits by schedule; limited indoor visits by phase.	483.80(h).	Proclamation 21-14 (Aug. 9, 2021): workers in any Health Care Setting (including residential long-term care facilities, nursing homes, assisted living facilities, adult family homes and hospice care centers) and long-term care workers unless excluded must be fully vaccinated on or before Oct. 18, 2021; the 'Health Care Provider' definition excludes 'providers of personal care in a person's home, such as home care, home health or hospice care' and individual providers (Ex. SEC-04-032); Proclamation 21-14.1 (Aug. 20, 2021) amended (Ex. SEC-04-061).	The proclamation's exclusion of in-home personal care providers is stated in its text (above); long-term care workers in facilities are covered.	Proclamations 21-14, 21-14.1; Secretary of Health mask order (State file); federal layer.	IC; HR; WF; RS; VS	SEC-04-032; SEC-04-061	Primary source read (21-14, 21-14.1); Confirmed from a secondary source (2020 proclamation identities)
West VirginiaWV	WV		Visits restored late August 2020; restrictions vary by county transmission; compassionate care in all counties.	Unchanged.	483.80(h).	None statewide.	None identified.	Federal layer.	VS; RS; IC	SEC-04-001; SEC-04-003	Confirmed from a secondary source (AARP).
WisconsinWI	WI	DHS LTC facility guidelines.	Outdoor visits by schedule; indoor compassionate care only (DHS guidelines).	Unchanged.	483.80(h).	None statewide.	None identified.	Federal layer.	VS; RS; IC	SEC-04-001; SEC-04-003	Confirmed from a secondary source (AARP).
WyomingWY	WY	The Wyoming Department of Health preserved the CMS QSO-20-39-NH REVISED 04/27/2021 text used as Ex. SEC-04-003.	Outdoor visits by schedule; indoor compassionate care only.	Unchanged.	483.80(h).	None statewide.	None identified.	Federal layer.	VS; RS; IC	SEC-04-001; SEC-04-003	Confirmed from a secondary source (AARP).

Sector instruments in the Library

The 70 instruments filed under this industry's own sector: regulators' rules and orders, federal directives aimed at it, and the context documents that describe them, in date order. Open the list in the Library to filter by type and quarter, or download the exhibits.

Exhibit	Instrument	Issuer	Date	Types	Quarters
Ex. SEC-04-015	COVID-19 Emergency Declaration Blanket Waivers for Health Care Providers (LTC facilities, HHAs, hospices, ICF/IIDs)COVID-19 Emergency Declaration Blanket Waivers for Health Care Providers	Centers for Medicare & Medicaid Services (section 1135 waiver authority)	Mar. 1, 2020	Health care ordersWorkplace rulesOther	2020 Q22020 Q32020 Q42021 Q12021 Q22021 Q3
Ex. SEC-04-017	CMS-1744-IFC, 85 Fed. Reg. 19230Medicare and Medicaid Programs; Policy and Regulatory Revisions in Response to the COVID-19 Public Health Emergency	Centers for Medicare & Medicaid Services	Mar. 1, 2020	Health care ordersOther	2020 Q22020 Q32020 Q42021 Q12021 Q22021 Q3
Ex. SEC-04-078	Appendix K: Emergency Preparedness and Response and COVID-19 Addendum to the Community HealthChoices and OBRA 1915(c) waivers (combined; final amendment fixing the end date)Appendix K: Emergency Preparedness and Response	Centers for Medicare & Medicaid Services (approval) on the application of the Pennsylvania Department of Human Services, Office of Long-Term Living	Mar. 6, 2020	Health care ordersWorkplace rulesOther	2020 Q22020 Q32020 Q42021 Q12021 Q22021 Q3
Ex. SEC-04-011	QSO-20-16-HospiceGuidance for Infection Control and Prevention Concerning Coronavirus Disease 2019 (COVID-19) in Hospice Agencies	Centers for Medicare & Medicaid Services	Mar. 9, 2020	Health care ordersWorkplace rules	2020 Q22020 Q32020 Q42021 Q12021 Q22021 Q3
Ex. SEC-04-010	QSO-20-18-HHAGuidance for Infection Control and Prevention Concerning Coronavirus Disease 2019 (COVID-19) in Home Health Agencies (HHAs)	Centers for Medicare & Medicaid Services, Quality, Safety & Oversight Group	Mar. 10, 2020	Health care ordersWorkplace rules	2020 Q22020 Q32020 Q42021 Q12021 Q22021 Q3
Ex. SEC-04-001	QSO-20-14-NH (REVISED)Guidance for Infection Control and Prevention of Coronavirus Disease 2019 (COVID-19) in nursing homes (REVISED)	Centers for Medicare & Medicaid Services, Quality, Safety & Oversight Group	Mar. 13, 2020	Gathering capHealth care ordersWorkplace rules	2020 Q22020 Q3
Ex. SEC-04-063	Memorandum to Home Health Agency and Hospice Administrators: Temporary Operational WaiversTemporary Operational Waivers for Home Health Agencies and Hospices during the COVID-19 emergency	New Jersey Department of Health, Certificate of Need and Licensing	Mar. 13, 2020	Health care ordersOther	2020 Q22020 Q32020 Q42021 Q12021 Q2
Ex. SEC-04-068	All Facilities Letter 20-22 (Mar. 13, 2020), as revised through AFL 20-22.9 (Aug. 12, 2021)Guidance for Limiting the Transmission of COVID-19 in Skilled Nursing Facilities: Visitation	California Department of Public Health, Center for Health Care Quality, Licensing and Certification Program	Mar. 13, 2020	Gathering capHealth care ordersWorkplace rules	2020 Q22020 Q32020 Q42021 Q12021 Q22021 Q3
Ex. SEC-04-040	DEM Emergency Order No. 20-006In re: COVID-19 Public Health Emergency (prohibiting visitation to long-term care and similar facilities)	Jared Moskowitz, Director, Florida Division of Emergency Management, under Executive Order 20-52	Mar. 15, 2020	Gathering capHealth care orders	2020 Q22020 Q3
Ex. SEC-04-018	QSO-20-20-AllPrioritization of Survey Activities	Centers for Medicare & Medicaid Services	Mar. 23, 2020	Workplace rulesOther	2020 Q22020 Q3
Ex. SEC-04-039	Executive Order No. 120Additional Limitations on Mass Gatherings, Restrictions on Venues and Long Term Care Facilities, and Extension of School Closure Date	Governor Roy Cooper	Mar. 23, 2020	Business closureGathering capSchools and child careHealth care orders	2020 Q2
Ex. SEC-04-013	QSO-20-23-ICF/IID & PRTFGuidance for Infection Control and Prevention of Coronavirus Disease 2019 (COVID-19) in Intermediate Care Facilities for Individuals with…	Centers for Medicare & Medicaid Services	Mar. 30, 2020	Gathering capHealth care orders	2020 Q22020 Q32020 Q4
Ex. SEC-04-047	Order of the Health Commissioner regarding Long-Term Care FacilitiesOrder Regarding Long-Term Care Facilities (COVID-19)	Health Commissioner, Philadelphia Department of Public Health	Apr. 8, 2020	Health care ordersWorkplace rulesQuarantine and isolation	2020 Q22020 Q3
Ex. SEC-04-060	Executive Order 04.08.20.03Ensuring the safety of employees and residents of nursing homes and long-term care facilities in response to COVID-19	Governor Brian P. Kemp	Apr. 8, 2020	Health care ordersWorkplace rulesQuarantine and isolation	2020 Q2
Ex. SEC-04-026	QSO-20-25-NH2019 Novel Coronavirus (COVID-19) Long-Term Care Facility Transfer Scenarios	Centers for Medicare & Medicaid Services	Apr. 13, 2020	Health care ordersQuarantine and isolation	2020 Q22020 Q32020 Q42021 Q12021 Q22021 Q3
Ex. SEC-04-064	Blanket Waiver for Home Health Agency Licensing Standards at N.J.A.C. 8:42 that are More Stringent than Waivers and Guidance Issued by CMS during the Public Health EmergencyBlanket Waiver for Home Health Agency Licensing Standards	Commissioner of Health	Apr. 24, 2020	Health care ordersOther	2020 Q22020 Q32020 Q42021 Q12021 Q2
Ex. SEC-04-006	CMS-5531-IFC, 85 Fed. Reg. 27550Medicare and Medicaid Programs, Basic Health Program, and Exchanges; Additional Policy and Regulatory Revisions in Response to the COVID-19…	Centers for Medicare & Medicaid Services	May 8, 2020	Health care ordersWorkplace rules	2020 Q22020 Q32020 Q42021 Q12021 Q22021 Q3
Ex. SEC-04-007	QSO-20-29-NHInterim Final Rule Updating Requirements for Notification of Confirmed and Suspected COVID-19 Cases Among Residents and Staff in Nursing…	Centers for Medicare & Medicaid Services	May 8, 2020	Health care ordersWorkplace rules	2020 Q22020 Q32020 Q42021 Q12021 Q22021 Q3
Ex. SEC-04-049	Executive Order No. 202.30Continuing Temporary Suspension and Modification of Laws Relating to the Disaster Emergency	Governor Andrew M. Cuomo	May 10, 2020	Health care ordersWorkplace rulesQuarantine and isolation	2020 Q22020 Q32020 Q42021 Q12021 Q2
Ex. SEC-04-042	Executive Directive No. 20-013 (revised May 20, 2020)Long-Term Care Facility COVID-19 Testing Plan and Staff Testing Requirements	Judith M. Persichilli, Commissioner, New Jersey Department of Health	May 12, 2020	Health care ordersWorkplace rulesQuarantine and isolation	2020 Q22020 Q3
Ex. SEC-04-012	QSO-20-30-NH (REVISED 03/10/2021)Nursing Home Reopening Recommendations for State and Local Officials	Centers for Medicare & Medicaid Services	May 18, 2020	Gathering capHealth care orders	2020 Q22020 Q32020 Q42021 Q1
Ex. SEC-04-062	DEM Emergency Order No. 20-007In re: COVID-19 Public Health Emergency (extending the long-term care visitation prohibition)	Director, Florida Division of Emergency Management	May 18, 2020	Gathering capHealth care orders	2020 Q22020 Q3
Ex. SEC-04-019	QSO-20-31-All (REVISED 01/04/2021)Revised COVID-19 Survey Activities, CARES Act Funding, Enhanced Enforcement for Infection Control deficiencies, and Quality Improvement…	Centers for Medicare & Medicaid Services	June 1, 2020	Workplace rulesOther	2020 Q22020 Q32020 Q4
Ex. SEC-04-069	All Facilities Letter 20-53 (June 9, 2020), as revised through AFL 20-53.6 (Dec. 27, 2021)COVID-19 Mitigation Plan Implementation and Testing Requirements for Skilled Nursing Facilities	California Department of Public Health, Licensing and Certification Program	June 9, 2020	Health care ordersWorkplace rulesVaccination or testingQuarantine and isolation	2020 Q22020 Q32020 Q42021 Q12021 Q22021 Q3
Ex. SEC-04-050	Order of the Secretary of the Pennsylvania Department of Health Directing Testing at Long-Term Care Facilities (June 26, 2020), with the June 8, 2020 order for skilled nursing facilitiesRequirements for Testing of Residents and Staff in Long-Term Care Facilities	Secretary of the Pennsylvania Department of Health (order); Department of Human Services (implementing page)	June 26, 2020	Health care ordersWorkplace rules	2020 Q22020 Q3
Ex. SEC-04-072	DEM Emergency Order No. 20-008In re: COVID-19 Public Health Emergency (extending the long-term care visitation prohibition)	Director, Florida Division of Emergency Management	July 13, 2020	Gathering capHealth care orders	2020 Q3
Ex. SEC-04-020	QSO-20-35-ALLEnforcement Cases Held during the Prioritization Period and Revised Survey Prioritization	Centers for Medicare & Medicaid Services	Aug. 17, 2020	Workplace rulesOther	2020 Q32020 Q42021 Q1
Ex. SEC-04-043	Executive Directive No. 20-026Resumption of Services in All Long-Term Care Facilities	Commissioner of Health	Aug. 20, 2020	Gathering capHealth care ordersWorkplace rulesQuarantine and isolation	2020 Q32020 Q42021 Q12021 Q22021 Q3
Ex. SEC-04-005	QSO-20-38-NHInterim Final Rule (IFC), CMS-3401-IFC, Additional Policy and Regulatory Revisions in Response to the COVID-19 Public Health Emergency…	Centers for Medicare & Medicaid Services, Survey and Certification Group	Aug. 26, 2020	Health care ordersWorkplace rulesQuarantine and isolation	2020 Q32020 Q42021 Q12021 Q22021 Q3
Ex. SEC-04-041	DEM Emergency Order No. 20-009In re: Suspension of Statutes, Rules, and Orders, Pursuant to Executive Order Number 20-52 (revising long-term care visitation restrictions)	Jared Moskowitz, Director, Florida Division of Emergency Management	Sept. 1, 2020	Gathering capHealth care orders	2020 Q32020 Q4
Ex. SEC-04-004	CMS-3401-IFC, 85 Fed. Reg. 54820Medicare and Medicaid Programs, Clinical Laboratory Improvement Amendments (CLIA), and Patient Protection and Affordable Care Act…	Centers for Medicare & Medicaid Services, Department of Health and Human Services	Sept. 2, 2020	Health care ordersWorkplace rulesQuarantine and isolation	2020 Q32020 Q42021 Q12021 Q22021 Q3
Ex. SEC-04-002	QSO-20-39-NHNursing Home Visitation - COVID-19	Centers for Medicare & Medicaid Services, Survey and Certification Group	Sept. 17, 2020	Gathering capHealth care ordersWorkplace rules	2020 Q32020 Q42021 Q1
Ex. SEC-04-048	Order Rescinding the Long-Term Care Facility OrderOrder Rescinding the Order Regarding Long-Term Care Facilities	Health Commissioner, Philadelphia Department of Public Health	Sept. 23, 2020	Health care orders	2020 Q3
Ex. SEC-04-075	Sixth Amended Director's Order to Limit Access to Ohio's Nursing Homes and Similar Facilities, with Exceptions	Director of Health, Ohio Department of Health	Jan. 7, 2021	Gathering capHealth care ordersWorkplace rules	2021 Q12021 Q2
Ex. SEC-04-016	QSO-21-14-ICF/IID & PRTF (REVISED 06/03/2021)Visitation at Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF/IIDs) and Psychiatric Residential Treatment…	Centers for Medicare & Medicaid Services	Feb. 10, 2021	Gathering capHealth care orders	2021 Q12021 Q22021 Q3
Ex. SEC-04-003	QSO-20-39-NH REVISED 04/27/2021Nursing Home Visitation - COVID-19 (REVISED)	Centers for Medicare & Medicaid Services, Quality, Safety & Oversight Group	Apr. 27, 2021	Gathering capHealth care ordersWorkplace rules	2021 Q22021 Q3
Ex. SEC-04-076	Director's Amended Order for the Testing of the Residents and Staff of all Nursing Homes (2021 amendment)Director's Amended Order for the Testing of the Residents and Staff of all Nursing Homes	Director of Health, Ohio Department of Health	May 4, 2021	Health care ordersWorkplace rules	2021 Q22021 Q3
Ex. SEC-04-025	QSO-21-17-NH (UPDATED 05/10/2021)Updates to Long-Term Care (LTC) Emergency Regulatory Waivers issued in response to COVID-19	Centers for Medicare & Medicaid Services	May 10, 2021	Health care ordersWorkplace rulesOther	2021 Q22021 Q3
Ex. SEC-04-008	CMS-3414-IFC, 86 Fed. Reg. 26306Medicare and Medicaid Programs; COVID-19 Vaccine Requirements for Long-Term Care (LTC) Facilities and Intermediate Care Facilities for…	Centers for Medicare & Medicaid Services	May 21, 2021	Health care ordersWorkplace rulesVaccination or testing	2021 Q22021 Q3
Ex. SEC-04-009	QSO-21-19-NHInterim Final Rule - COVID-19 Vaccine Immunization Requirements for Residents and Staff	Centers for Medicare & Medicaid Services	May 21, 2021	Health care ordersWorkplace rulesVaccination or testing	2021 Q22021 Q3
Ex. SEC-04-014	29 C.F.R. 1910.502, 86 Fed. Reg. 32376 (COVID-19 Healthcare Emergency Temporary Standard)Occupational Exposure to COVID-19; Emergency Temporary Standard	Occupational Safety and Health Administration, Department of Labor	June 21, 2021	Face-covering requirementHealth care ordersWorkplace rulesVaccination or testingQuarantine and isolation	2021 Q22021 Q3
Ex. SEC-04-023	29 C.F.R. 1910.502 (2021 edition, revised as of July 1, 2021)Healthcare	Office of the Federal Register (codification of the OSHA ETS)	June 21, 2021	Face-covering requirementHealth care ordersWorkplace rulesVaccination or testingQuarantine and isolation	2021 Q22021 Q3
Ex. SEC-04-035	State Public Health Officer Order of August 5, 2021Health Care Worker Vaccine Requirement	State Public Health Officer and Director, California Department of Public Health (Tomas J. Aragon)	Aug. 5, 2021	Health care ordersWorkplace rulesVaccination or testing	2021 Q3
Ex. SEC-04-031	Executive Order No. 13BProtection of Public Health and Safety During COVID-19 Pandemic - Long-Term Care Facility Staff Vaccination	Governor Ned Lamont	Aug. 6, 2021	Health care ordersWorkplace rulesVaccination or testing	2021 Q3
Ex. SEC-04-032	Proclamation 21-14COVID-19 Vaccination Requirement (amending Proclamation 20-05, et seq.)	Governor Jay Inslee	Aug. 9, 2021	Health care ordersWorkplace rulesVaccination or testing	2021 Q3
Ex. SEC-04-036	State Public Health Officer Order of July 26, 2021Health Care Worker Protections in High-Risk Settings	State Public Health Officer and Director, California Department of Public Health	Aug. 9, 2021	Face-covering requirementHealth care ordersWorkplace rulesVaccination or testing	2021 Q3
Ex. SEC-04-059	Mayor's Order 2021-099COVID-19 Vaccination Certification Requirement for District Government Employees, Contractors, Interns, and Grantees	Mayor Muriel Bowser	Aug. 10, 2021	Workplace rulesVaccination or testing	2021 Q3
Ex. SEC-04-045	Emergency Regulation Governing the Control and Prevention of COVID-19 Mandating Vaccines for Healthcare Workers and In Higher Education, Healthcare, and Related Settings	Philadelphia Board of Health; Department of Public Health (Acting Health Commissioner Cheryl Bettigole); approved by the City Law Department	Aug. 16, 2021	Health care ordersWorkplace rulesVaccination or testing	2021 Q3
Ex. SEC-04-053	216-RICR-20-15-8 (emergency regulation adopted Aug. 17, 2021; amended Feb. 10, 2022)Requirement for Immunization Against COVID-19 for All Workers in Licensed Health Care Facilities and Other Practicing Health Care Providers	Rhode Island Department of Health	Aug. 17, 2021	Health care ordersWorkplace rulesVaccination or testing	2021 Q3
Ex. SEC-04-024	CMS press release, Aug. 18, 2021Biden-Harris Administration Takes Additional Action to Protect America's Nursing Home Residents from COVID-19	Centers for Medicare & Medicaid Services (press release)	Aug. 18, 2021	Vaccination or testing	2021 Q3
Ex. SEC-04-061	Proclamation 21-14.1COVID-19 Vaccination Requirement (amending Proclamations 20-05 and 20-14)	Governor Jay Inslee	Aug. 20, 2021	Health care ordersWorkplace rulesVaccination or testing	2021 Q3
Ex. SEC-04-046	PDPH-HAN-00363AHealth Alert: Guidance Regarding the COVID-19 Vaccine Mandate for Healthcare Workers	Philadelphia Department of Public Health, Health Alert Network	Aug. 25, 2021	Health care ordersVaccination or testing	2021 Q3
Ex. SEC-04-058	10 NYCRR 2.61 (emergency regulation)Prevention of COVID-19 Transmission by Covered Entities	Public Health and Health Planning Council and Commissioner of Health, New York State Department of Health	Aug. 26, 2021	Health care ordersWorkplace rulesVaccination or testing	2021 Q3
Ex. SEC-04-033	Executive Order 2021-20 (COVID-19 Executive Order No. 87)Executive Order requiring face coverings indoors and vaccination or testing of health care workers, school personnel, higher education and…	Governor JB Pritzker	Aug. 30, 2021	Face-covering requirementHealth care ordersWorkplace rulesVaccination or testing	2021 Q3
Ex. SEC-04-065	Governor's Aug. 18, 2021 vaccination protocols for nursing home and hospital staff (as reported by WBOC)Hogan Institutes Stricter Vaccine Protocols for Workers at Md. Nursing Homes, Hospitals	Governor Lawrence J. Hogan, Jr. (announcement); Maryland Department of Health (implementing order)	Sept. 1, 2021	Health care ordersWorkplace rulesVaccination or testing	2021 Q3
Ex. SEC-04-034	Executive Order 2021-22 (COVID-19 Executive Order No. 88)Executive Order amending the vaccination and testing requirements of EO 2021-20	Governor JB Pritzker	Sept. 3, 2021	Face-covering requirementHealth care ordersWorkplace rulesVaccination or testing	2021 Q3
Ex. SEC-04-051	Executive Order No. 13FProtection of Public Health and Safety During COVID-19 Pandemic - Long-Term Care Facility Staff Vaccination	Governor Ned Lamont	Sept. 3, 2021	Health care ordersWorkplace rulesVaccination or testing	2021 Q3
Ex. SEC-04-030	Executive Order No. 252Requiring covered workers in health care facilities and high-risk congregate settings to be fully vaccinated or undergo regular testing	Governor Philip D. Murphy	Sept. 7, 2021	Health care ordersWorkplace rulesVaccination or testing	2021 Q3
Ex. SEC-04-073	QSO-20-38-NH REVISED 09/10/2021Interim Final Rule (IFC), CMS-3401-IFC, Additional Policy and Regulatory Revisions in Response to the COVID-19 Public Health Emergency…	Centers for Medicare & Medicaid Services	Sept. 10, 2021	Health care ordersWorkplace rulesQuarantine and isolation	2021 Q3
Ex. SEC-04-052	Executive Order No. 13DProtection of Public Health and Safety During COVID-19 Pandemic - Vaccinations Required for State Employees, School Employees and Childcare…	Governor Ned Lamont	Sept. 27, 2021	Workplace rulesVaccination or testing	2021 Q3
Ex. SEC-04-057	Governor's announcement of Aug. 16, 2021 and DOH Section 16 ordersGovernor Cuomo Announces COVID-19 Vaccination Mandate for Healthcare Workers	Governor Andrew M. Cuomo (release); New York State Department of Health (Section 16 orders)	Sept. 27, 2021	Health care ordersVaccination or testing	2021 Q3
Ex. SEC-04-037	State Public Health Officer Order of September 28, 2021Adult Care Facilities and Direct Care Worker Vaccine Requirement	State Public Health Officer and Director, California Department of Public Health	Sept. 28, 2021	Health care ordersWorkplace rulesVaccination or testing	2021 Q3
Ex. SEC-04-055	DHSS announcement of vaccination-or-testing requirements for long-term care facilities, health care facilities and State employeesCOVID-19 Vaccination and Testing Updates for Long-Term Care Facilities, Health Care Facilities, and State Employees	Delaware Department of Health and Social Services / Division of Public Health (release)	Sept. 30, 2021	Health care ordersWorkplace rulesVaccination or testing	2021 Q3
Ex. SEC-04-056	Governor's release and letter of Aug. 17, 2021 urging expedited Board of Health rulemakingGovernor Polis Urges State Board of Health to Engage in Expedited Rulemaking to Require COVID-19 Vaccine for All Personnel Working Directly…	Governor Jared Polis (letter to the State Board of Health)	Sept. 30, 2021	Health care ordersWorkplace rulesVaccination or testing	2021 Q3
Ex. SEC-04-022	42 C.F.R. 483.80 (2021 edition, revised as of Oct. 1, 2021)Infection control	Office of the Federal Register (codification of CMS rules)	Oct. 1, 2021	Health care ordersWorkplace rulesVaccination or testing
Ex. SEC-04-066	10-144 C.M.R. ch. 264 (emergency rule of Aug. 12, 2021), as described in Does 1-6 v. Mills, No. 21-1826 (1st Cir. Oct. 19, 2021)Immunization Requirements for Healthcare Workers (COVID-19 emergency rule)	Maine Center for Disease Control and Prevention, Department of Health and Human Services (emergency rule); First Circuit (description)	Oct. 1, 2021	Health care ordersWorkplace rulesVaccination or testing	2021 Q3
Ex. SEC-04-067	OHA Frequently Asked Questions on the COVID-19 vaccination requirement for healthcare providers and staff (OAR 333-019-1010) and K-12 (OAR 333-019-1030)COVID-19 Vaccination Requirements: Frequently Asked Questions (le3874)	Oregon Health Authority, Public Health Division	Oct. 18, 2021	Health care ordersWorkplace rulesVaccination or testing	2021 Q3
Ex. SEC-04-021	CMS-3415-IFC, 86 Fed. Reg. 61555Medicare and Medicaid Programs; Omnibus COVID-19 Health Care Staff Vaccination	Centers for Medicare & Medicaid Services	Nov. 5, 2021	Health care ordersVaccination or testing
Ex. SEC-04-077	QSO-20-39-NH REVISED 11/12/2021Nursing Home Visitation - COVID-19 (REVISED)	Centers for Medicare & Medicaid Services	Nov. 12, 2021	Health care orders
Ex. SEC-04-044	Executive Directive No. 21-012 (revised Dec. 22, 2022)Directive for the Resumption of Services in all Long-Term Care Facilities licensed pursuant to N.J.A.C. 8:43, 8:36, 8:39 and 8:37	Commissioner of Health	Dec. 22, 2022	Health care orders

Third quarter of 2021: the instruments in force

The quarter the Service's letters most often dispute. The record shows these instruments in force on this industry's functions between July 1 and September 30, 2021; an order in force on any day of the quarter is an order in force during it, and the State, metropolitan and federal layers on the quarter page add to the list.

In force, July 1 – Sept. 30, 2021

SEC-04-014 / SEC-04-023: 29 C.F.R. 1910.502, 86 Fed. Reg. 32376 (June 21, 2021), all quarter (compliance July 6 and July 21, 2021)
SEC-04-004 / SEC-04-022 / SEC-04-073: 42 C.F.R. 483.80(h) testing (CMS-3401-IFC); QSO-20-38-NH REVISED 04/27/2021 to Sept. 10, 2021, then REVISED 09/10/2021
SEC-04-006 / SEC-04-007: 42 C.F.R. 483.80(g) NHSN reporting
SEC-04-008 / SEC-04-009: 42 C.F.R. 483.80(d)(3) vaccine education, offering and reporting (effective May 21, 2021)
SEC-04-003: QSO-20-39-NH REVISED 04/27/2021 (visitation limits) until REVISED 11/12/2021 (SEC-04-077)
SEC-04-016: QSO-21-14-ICF/IID and PRTF REVISED 06/03/2021 (visitation)
SEC-04-015 / SEC-04-025: section 1135 blanket waivers for LTC facilities, HHAs and hospices as narrowed by QSO-21-17-NH
SEC-04-017: CMS-1744-IFC telehealth, homebound and face-to-face rules (PHE)
SEC-04-078: Pennsylvania Appendix K (Mar. 6, 2020 to May 11, 2023) as the exemplar of the Appendix K instruments in force in every State
SEC-04-036: California SPHO Order of July 26, 2021 (effective Aug. 9; full compliance Aug. 23, 2021)
SEC-04-035: California SPHO Order of Aug. 5, 2021 (fully vaccinated by Sept. 30, 2021)
SEC-04-037: California SPHO Order of Sept. 28, 2021 (in-home direct care, home care aides, home health aides, hospice, adult and senior care facilities; Nov. 30, 2021 deadline)
SEC-04-068: California AFL 20-22.9 (Aug. 12, 2021) SNF visitation and visitor testing
SEC-04-030: New Jersey EO 252 (Aug. 6, 2021; effective Sept. 7, 2021)
SEC-04-031 / SEC-04-051: Connecticut EO 13B (Aug. 6, 2021) and EO 13F (Sept. 3, 2021)
SEC-04-032 / SEC-04-061: Washington Proclamations 21-14 (Aug. 9, 2021) and 21-14.1 (Aug. 20, 2021)
SEC-04-057 / SEC-04-058: New York DOH 10 NYCRR 2.61 (effective Aug. 26, 2021)
SEC-04-033 / SEC-04-034: Illinois EO 2021-20 (Aug. 26, 2021) and EO 2021-22 (Sept. 3, 2021)
SEC-04-045 / SEC-04-046: Philadelphia Board of Health Emergency Regulation (adopted Aug. 12; effective Aug. 16, 2021)
SEC-04-053: Rhode Island 216-RICR-20-15-8 (emergency adoption Aug. 17, 2021)
SEC-04-066: Maine CDC emergency rule 10-144 CMR ch. 264 (Aug. 12, 2021) as described by the First Circuit
SEC-04-067: Oregon OAR 333-019-1010 (temporary adoptions Aug. 5, Aug. 25 and Sept. 1, 2021)
SEC-04-055: Delaware DHSS vaccination-or-testing requirement (announced Aug. 12, 2021; from Sept. 30, 2021)
SEC-04-065: Maryland nursing home and hospital staff requirement (Aug. 18, 2021; first dose by Sept. 1, 2021)
SEC-04-056: Colorado Board of Health emergency rulemaking (requested Aug. 17, 2021; adopted Aug. 30, 2021 per secondary sources)
SEC-04-024: CMS announcement of Aug. 18, 2021 (nursing home staff vaccination condition to be issued)
SEC-04-076: Ohio Director's Amended Order for testing of nursing home residents and staff (2021 amendment; captured July 18, 2021)
SEC-04-043: New Jersey Executive Directive 20-026 (Aug. 20, 2020) phased resumption in force all quarter.
Massachusetts nursing home staff vaccination requirement (announced Aug. 4, 2021; enforcement Oct. 10, 2021) (verified_secondary; no exhibit)
District of Columbia health care worker vaccination requirement (DC Health, Aug. 16, 2021; Sept. 30, 2021 deadline) (verified_secondary; no exhibit)

The third quarter of 2021 across every State, and this industry's quarter analysis.

Group meetings, trade shows and seasons disrupted

The organizers' own notices of the trade shows, conventions, conferences and seasons of this industry that the orders cancelled, postponed or moved online: 36 notices, each graded and sourced. The Suspension Clause names “group meetings” in terms.

Date	Organizer notice	Grade	Exhibit and source
Mar. 13, 2020	Communal dining in Medicare- and Medicaid-certified nursing homes (DN)	Primary source read	Ex. SEC-04-GM-004 Open · Source
Mar. 19, 2020	Annual Assembly of Hospice and Palliative Care (AAHPM and HPNA)	Primary source read	Ex. SEC-04-GM-002 Open · Source
Mar. 20, 2020	LeadingAge Annual Meeting & EXPO 2020	Primary source read	Ex. SEC-04-GM-034 Open · Source
Mar. 24, 2020	Nurse aide competency examinations, NCLEX and administrator licensing examinations at Prometric and Pearson VUE test centers (HR: the pipeline of certified nursing assistants, home health aides, licensed nurses and licensed administrators)	Primary source read	Ex. SEC-04-GM-014 Open · Source
Mar. 24, 2020	Nurse aide competency examinations, NCLEX and administrator licensing examinations at Prometric and Pearson VUE test centers (HR: the pipeline of certified nursing assistants, home health aides, licensed nurses and licensed administrators)	Primary source read	Ex. SEC-04-GM-015 Open · Source
Mar. 27, 2020	Argentum Senior Living Executive Conference & Expo 2020	Primary source read	Ex. SEC-04-GM-001 Open · Source
Mar. 28, 2020	Aging in America Conference 2020 (AiA20)	Primary source read	Ex. SEC-04-GM-018 Open · Source
Apr. 2, 2020	AGS 2020 Annual Scientific Meeting (#AGS20)	Primary source read	Ex. SEC-04-GM-019 Open · Source
Apr. 11, 2020	LeadingAge California Annual Conference and Expo 2020	Primary source read	Ex. SEC-04-GM-022 Open · Source
May 6, 2020	NHPCO Leadership and Advocacy Conference (LAC) 2020, with Hill Day	Primary source read	Ex. SEC-04-GM-009 Open · Source
May 10, 2020	CAHSAH Annual Conference & Expo 2020; Home Care & Hospice Administrator Certificate Programs	Primary source read	Ex. SEC-04-GM-027 Open · Source
May 19, 2020	NADONA 33rd Annual Conference 2020	Primary source read	Ex. SEC-04-GM-016 Open · Source
May 19, 2020	LeadingAge Leadership Summit 2020 (formerly the PEAK Leadership Summit)	Primary source read	Ex. SEC-04-GM-026 Open · Source
May 19, 2020	LeadingAge Leadership Summit 2020 (formerly the PEAK Leadership Summit)	Primary source read	Ex. SEC-04-GM-028 Open · Source
May 19, 2020	NADONA 33rd Annual Conference 2020	Primary source read	Ex. SEC-04-GM-038 Open · Source
June 2, 2020	NAHC Financial Management Conference & Expo 2020	Primary source read	Ex. SEC-04-GM-006 Open · Source
June 2, 2020	NAHC Financial Management Conference & Expo 2020	Primary source read	Ex. SEC-04-GM-037 Open · Source
July 5, 2020	Florida Senior Living Association 2020 Conference ('Celebrating the Magic of Senior Living')	Primary source read	Ex. SEC-04-GM-024 Open · Source
Aug. 2, 2020	Walk to End Alzheimer's 2020 (more than 600 community walks; home care and senior living operators are sponsors, team captains and exhibitors)	Primary source read	Ex. SEC-04-GM-013 Open · Source
Aug. 6, 2020	TAHC&H 51st Annual Meeting 2020	Primary source read	Ex. SEC-04-GM-032 Open · Source
Aug. 12, 2020	NAHC Home Care and Hospice Conference and Expo 2020 (the annual meeting)	Primary source read	Ex. SEC-04-GM-005 Open · Source
Aug. 12, 2020	NAHC Home Care and Hospice Conference and Expo 2020 (the annual meeting)	Primary source read	Ex. SEC-04-GM-029 Open · Source
Aug. 18, 2020	HCAOA Annual Leadership Conference 2020	Primary source read	Ex. SEC-04-GM-008 Open · Source
Aug. 18, 2020	HCAOA Annual Leadership Conference 2020	Primary source read	Ex. SEC-04-GM-036 Open · Source
Sept. 18, 2020	Texas Health Care Association 70th Annual Convention 2020	Primary source read	Ex. SEC-04-GM-025 Open · Source
Sept. 27, 2020	CAHF Annual Convention & Expo 2020	Primary source read	Ex. SEC-04-GM-023 Open · Source
Oct. 11, 2020	LeadingAge Annual Meeting & EXPO 2020	Primary source read	Ex. SEC-04-GM-031 Open · Source
Nov. 24, 2020	Home Care 100 (Lincoln Healthcare Leadership) 2021	Primary source read	Ex. SEC-04-GM-017 Open · Source
Jan. 13, 2021	AMDA - The Society for Post-Acute and Long-Term Care Medicine, Annual Conference (PALTC20 and PALTC21)	Primary source read	Ex. SEC-04-GM-012 Open · Source
Jan. 21, 2021	NIC Fall Conference 2020 and NIC Spring Conference 2021; NIC Fall Conference 2021	Primary source read	Ex. SEC-04-GM-035 Open · Source
Mar. 23, 2021	NIC Fall Conference 2020 and NIC Spring Conference 2021; NIC Fall Conference 2021	Primary source read	Ex. SEC-04-GM-021 Open · Source
Aug. 9, 2021	Argentum Senior Living Executive Conference & Expo 2021	Primary source read	Ex. SEC-04-GM-010 Open · Source
Aug. 9, 2021	HCAOA Annual Leadership Conference 2021	Primary source read	Ex. SEC-04-GM-020 Open · Source
Aug. 17, 2021	NAHC Home Care and Hospice Conference and Expo 2021	Primary source read	Ex. SEC-04-GM-030 Open · Source
Aug. 24, 2021	Argentum Senior Living Executive Conference & Expo 2021	Primary source read	Ex. SEC-04-GM-011 Open · Source
Aug. 31, 2021	AHCA/NCAL 71st Convention & Expo 2020	Primary source read	Ex. SEC-04-GM-033 Open · Source

All cancelled meetings in the Library.

Read the analysis

The analysis of this industry runs to seven further pages. Each carries its own notes and exhibit links.

Part 1 of 7How a typical employer operatesThe functions of the business, its revenue lines, its workforce, its suppliers and counterparties, its seasons, and how the orders reached each of them.Part 2 of 7The orders by layerFederal, State, metro, sector regulator, standing duty and counterparty: the instruments that reached this industry, layer by layer, with exhibit links.Part 3 of 7The six quartersWhat was in force on this industry's functions in each quarter from 2020 Q2 through 2021 Q3, with the third quarter of 2021 answered instrument by instrument.Part 4 of 7Function by functionEach function of the business, the orders that reached it and the change they compelled, one function at a time.Part 5 of 7The interconnected economyHow orders on suppliers, customers, carriers and workers reached this industry, and why an order's effect on a business outlasts the order's end date.Part 6 of 7The Service's positions, answeredThe fourteen sentences the Service's letters use, each quoted and answered for this industry from the public record.Part 7 of 7FindingsThe conclusions for each of the six quarters and the standard of proof they meet.