Jun 15 2020

The Centers for Medicare & Medicaid Services (CMS)

released guidance on restarting non-emergent non-COVID-19 healthcare. If states or regions have passed the Gating Criteria (symptoms, cases, and hospitals) the White House announced on April 16, 2020, then they may proceed to Phase I. These recommendations can guide healthcare systems and facilities as they consider resuming in-person care of non-COVID-19 patients in regions with a low incidence of COVID-19 disease.

Decisions must be consistent with public health information and in collaboration with state public health authorities. All facilities should continually evaluate whether their region remains at a low risk of incidence and should be prepared to cease non-essential procedures if a surge occurs. Adhering to the following recommendations can allow for safely extending in-person, non-emergent care in select communities and facilities.

The new recommendations can be found here: https://www.cms.gov/files/document/covid-flexibility-reopen-essential-non-covid-services.pdf

The Guidelines for Opening Up America Again can be found here: https://www.whitehouse.gov/openingamerica/#criteria

General Considerations

• In coordination with state and local public health officials, evaluate the incidence and trends for COVID-19 in the area where re-starting in-person care is being considered.
• Evaluate the necessity of the care based on clinical needs.
• Consider establishing Non-COVID Care (NCC) zones that would screen all patients for symptoms of COVID-19, including temperature checks. Staff would be screened routinely as would others who would work in the facility (physicians, nurses, housekeeping, delivery and all people who would enter the area). Sufficient resources should be available to the facility across phases of care, including personal protective equipment (PPE), healthy workforce, facilities, supplies, testing capacity and post-acute care, without jeopardizing surge capacity.

In addition to the general considerations, CMS outlines the following recommendations:

• PPE for staff and patients;
• workforce availability and staff screening;
• facility considerations, including social distancing in waiting areas and maintaining low patient volumes;
• sanitation protocols, including an established plan for thorough cleaning and disinfection prior to using spaces;
• adequate equipment, medication and supplies must be ensured and must not detract from the community’s ability to respond to a potential surge;
• all patients must be screened for potential symptoms of COVID-19 prior to entering the NCC facility, and staff must be routinely screened for potential symptoms; and when adequate testing capability is established, patients should be screened by laboratory testing befor care, and staff working in these facilities should be regularly screened by laboratory test as well.