The Governor and Colorado Department of Public Health (CDPHE) released a new Public Health Order (PHO) on November 17th adding an additional Purple level to the COVID Dial.   

Here is the link to the new PHO and website to help clarify.

• Updated Public Health Order 20-36:  https://drive.google.com/file/d/1N6ofsmJk5gGkEvX34UPD_b3vBmg5hrMz/view?usp=sharing

• Updated COVID Website and Dial: https://covid19.colorado.gov/covid-19-dial

The good news is that - at least so far - we have been given authorization to stay open and keep treating thru any county going to RED: STAY AT HOME.  

At the new PURPLE: STAY AT HOME level (for now) any acupuncture treatments (or any in-person treatments from a limited healthcare provider including physical therapists and chiropractors) will need an order from a “medical” provider.  While not ideal, we are working on this and will update you on any changes

FAQ Regarding Latest Update to Covid-19 Dial (Nov. 17, 2020):

What does the updated PHO actually mean for Acupuncturists?

In “Red:Stay At Home” it means the positivity rate of a county has exceeded 15% for 14 days.  Additionally, there are greater than 350 cases per 100,000 people.  Unless necessary, stay at home.  

Currently, if a county is in Orange:Safer at Home or Red:Stay at Home, acupuncturists can stay open with 25% of the Occupant Load of the building or business space, or 25 occupants (whichever is less). 

In “Purple:Stay at Home” it means hospital beds are at or near capacity and we risk having to deny critical care to people with life threatening conditions.  Unless necessary, stay at home.

Currently, if a county is in Purple:Stay at Home, acupuncturists must reduce their capacity to 10% and under the current PHO, treat patients only with an “order” from a medical doctor.

What can I do?

Operate within guidelines, and use best practices around distancing and sanitization. The minute a patient or practitioner contracts COVID-19 in an Acupuncture clinic/practice, our ability to negotiate for what we need crashes. 

Please do not flood your County Commissioners, State Legislators, CDPHE nor the Governor’s Office with phone calls at this time. It will not be productive during the internal bandwidth strain that the COVID-19 crisis is creating.

We understand that many acupuncturists are going to have a hard time getting thru the next couple of months and are also doubling our efforts to find funding and identify more grants.  This maybe a hard winter - but there is light at the end of the tunnel and we will all get thru this if we take care of each other.

On a side note, we were told this afternoon that currently we are the only healthcare profession currently given dispensation on glove wearing for needling.  So there is one win, and we promise we will continue to advocate for acupuncturists and our patients to be able to access their own healthcare.

Please feel free to email info@acucol.com with questions, keeping in mind that we have limited resources and it may take some time to get back to you.

What are Limited Healthcare Settings?

In the Updated PHO 20-36 as of Nov. 17, 2020 Limited Healthcare Settings have been defined as: 

J. Limited Healthcare Settings ​means those locations where certain healthcare services are provided, including acupuncture (not related to personal services), athletic training (not related to personal services), audiology services, services by hearing aid providers, chiropractic care, massage therapy (not related to personal services), naturopathic care, occupational therapy services, physical therapy, and speech language pathology services. Services provided in ​Limited Healthcare Settings​ that are ordered by a medical, dental or veterinary practitioner, are subject to the requirements of PHO 20-29; otherwise, the services are subject to the requirements of PHO 20-36.

In this PHO - 

Red: Stay at Home, Limited Healthcare Settings, including acupuncture clinics:

g. Limited Healthcare Settings​ may operate at 25% of the posted occupancy limit, not to exceed 25 people, per room to provide those services.

Purple: Stay at Home, Limited Healthcare Settings, including acupuncture clinics:

g. Limited Healthcare Settings​ that provide services that are ordered by a medical, dental or veterinary practitioner in accordance with Public Health Order 20-29 mayoperate at 10% of the posted occupancy limit, not to exceed 25 people, per room to provide those services. All other services offered by ​Limited Healthcare Settings​ are closed for in-person work but may continue to carry out ​Minimum Basic Operations​.

What are Personal Services?

In the Updated PHO 20-36 as of Nov 17, 2020, Personal Services have been defined as:

Q. Personal Services​ means services and products that are not necessary ​to maintain an individual’s health or safety, or the sanitation or essential operation of a business or residence. ​Personal Services ​include, but are not limited to,​ pastoral services except as specified in ​Appendix F​, personal training, dog grooming, or body art and also applies to noncritical professionals regulated by the Division of Professions and Occupation within the Department of Regulatory Agencies (DORA) including but not limited to services provided by personal beauty professionals such as hairstylists, barbers, cosmetologists, estheticians, nail technicians, as well as massage therapists, whose work requires these professionals to be less than six feet from the person for whom the services are being provided. Massage therapy services ordered by a healthcare professional should consult ​Executive Order D 2020 027, ​as amended and extended.

In this PHO - 

Red:Stay at Home Phase, personal services:

f. Personal Services​ may operate at 25% of the posted occupancy limit, not to exceed 25 people, whichever is less, per room.

In Purple: Stay at Home Phase, personal services:

f. Personal Services​ are closed for in-person work and services but may continue to carry out ​Minimum Basic Operations​.

Are we critical businesses?

No, we are still getting further clarification on this but based on our legal team’s current reading of the PHOs, we are NOT a critical business.  Even under Appendix A under 1.A. Healthcare Operations: Hospital, clinics and walk-in health facilities.

The specific orders and classifications in the Limited Healthcare Setting section clearly put us in this “bucket”.  No matter what phase, we should act as limited healthcare settings or personal services depending on our service, not as a critical business.  

Are we essential health workers?

We are working to get clarity of what this means and if there is an actual listing of essential health workers. There is a lot of concern around this and lawyers from many professions are working to get clarity here.  We will update you on this if we get any clearer understanding of any meaning.

As the AAC has said before, we are certainly essential to our patients.  

What does 25% and 10% capacity mean?

The capacity limits as outlined in the COVID-19 dial (https://covid19.colorado.gov/covid-19-dial) are an attempt to reduce the number of people in a given space. They are a percentage of the occupant load of your business and the type of business that is being conducted. 

Since we are being categorized as Limited Healthcare Settings, we must abide by the capacity restrictions listed. 25%, 25 means that we are limited to 25% of the Occupant Load of the building or business space, or 25 occupants (whichever is less). Similarly, 10%, 10 means we are limited to 10% of our Occupant Load or 10 occupants, whichever is less.

Maximum Occupant Loads are determined by evaluating the overall square footage of the space and the type of business being conducted in that space. Typically, outpatient medical services require 100 square feet per occupant, although the exact requirement is subject to determination by your county. To make a rough estimate of your Maximum Occupant Load, take the square footage of your office space and divide by the 100 square feet per occupant. 

For example, if your office is 1500 square feet, divide by 100 to arrive at a Maximum Occupant Limit of 15 people. Then reduce by the percentage based on your position on the dial to arrive at the Maximum Occupant Limit for your county’s risk limit. So in the above example, if the risk level is Orange: High Risk, then 15 is reduced to 25% or 3.75, which rounds to 4 occupants. Since 4 is less than the 25 person limit, the Maximum Occupant Limit of this space would be 4 occupants.

If your office space has an official occupancy sign (like those seen in restaurants) then you may simply apply the percentages on the dial to the number on the occupancy sign to arrive at your adjusted Maximum Occupant Limit.

We are currently seeking clarification as to how these adjusted limits apply to very small spaces where the Maximum Occupant Limit would be 1.

Also, please keep in mind that you may only include square footage that is able to meet all existing distancing and sanitation guidelines. Any square footage that cannot meet the guidelines cannot be counted towards calculating your Maximum Occupant Limit.

For further guidance on how to calculate your capacity, please check out with your county fire department.  Some of the county resources we have found are: 

• Larimar: https://lfra.org/how-businesses-can-determine-maximum-occupancy/

• Boulder:https://www-static.bouldercolorado.gov/docs/Occupant_load_information-1-202006041442.pdf

Aren’t we medical?

Not according to CDPHE definitions.  We are Limited Healthcare Providers, which is different.

What about telehealth?

In every case, we are encouraged to do telehealth whenever possible.  Herb and supplement pick up should resume to contactless and be mailed if possible.

Link to All Previous Executive and Public Health Orders

Colorado Department of Public Health Website Listing Acupuncturists under "Limited Healthcare Settings"