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Title: Section 360.1 - Administrative Purpose, Application and Scope

Effective Date


Section 360.1. Administrative Purpose, Application and Scope

(a) Administrative purpose.

Hospitals across New York State, prior to the COVID-19 pandemic, rarely worked together or coordinated as a unified system. But a pandemic on the scale of the COVID-19 crisis demonstrated that hospitals could not meet the demand of the moment unless a new and innovative system was put into place requiring unprecedented coordination, cooperation, and agility. The New York State Department of Health takes note of the successful implementation of the Surge and Flex System by New York State’s hospitals and offers these regulations as an additional way to strengthen the pandemic response. Surge and Flex Health Coordination System Activation has helped hospitals respond to the COVID‑19 state disaster emergency, and New York’s hospitals have made commendable efforts to coordinate their response to the pandemic, to direct patients to the hospitals with the capacity to treat them, and to increase capacity as needed, during each wave of the pandemic.

The COVID-19 crisis demanded a new coordinated approach to ensure no one hospital was overwhelmed by COVID-19 patients or needed more ventilators, while a hospital nearby had capacity for more patients and excess equipment. It was imperative for government to coordinate and organize all hospitals under the umbrella of one unified system, and efficiently use all the resources available in the state to attempt to meet the significant demands of the crisis.

The “Surge and Flex” system is designed to create a single, coordinated statewide system to prevent a disaster from overwhelming any one hospital in the state. The purpose of this NYSDOH regulation is to institutionalize Surge and Flex operation, giving hospitals the time and guidance to adequately prepare for a potential future activation of Surge and Flex. This regulation provides the Department of Health with the necessary tools to enact Surge and Flex operation during another wave of COVID-19, or a future public health emergency. Further, this regulation is designed to help each hospital prepare for this contingency in order to ensure a straightforward transition from standard operating procedures to “Surge and Flex.”

(b) Application and Scope. In the event of a State disaster emergency declared pursuant to section 28 of the Executive Law, the Commissioner may exercise the authorities granted in this Part, thereby maximizing the efficiency and effectiveness of the State’s hospital systems and mitigating the threat to the health of the people of New York. Further, this Part establishes certain ongoing emergency planning requirements, called the Surge and Flex Health Care Coordination System, for facilities and agencies regulated by the Department.

To the extent that any provision of this Part conflicts with any other regulation of the Department, this Part shall take precedence. All authorities granted to the Commissioner shall be subject to any conditions and limitations that the Commissioner may deem appropriate. The Commissioner may delegate activation of the authorities provided by this Part to appropriate executive staff within the Department. In the event that there are inconsistent statutes, which would preclude effectiveness of such regulation, such regulation shall be effective upon the suspension of such inconsistent statute by the Governor pursuant to authority in Article 2-B of the Executive Law, and such regulation shall immediately be effective.

Statutory Authority

Public Health Law, Sections 225, 576, 2800, 2803 and 4662 & Social Services Law, Section 461


VOLUME C (Title 10)