On April 19, 2020, the Centers for Medicare & Medicaid Services (CMS) issued recommendations for Re-opening Facilities to Provide Non-emergent Non-COVID-19 Healthcare: Phase I. The recommendations apply to areas with a low, or relatively low and stable incidence of COVID-19, in states or regions that have passed Phase I gating criteria that were previously announced by the Administration on April 16, 2020. Initially, the recommendations apply to non-emergent care that is currently on hold, such as chronic disease care, surgery and other procedures, and, eventually, preventive care. CMS is strongly urging maximum use of telehealth.  For healthcare systems and facilities that are considering resuming in-person care, CMS recommends careful planning with state public health authorities. The recommendations also caution that all facilities should continually evaluate whether their area continues to have a low incidence of COVID-19 and be prepared to cease non-essential procedures if there is a surge.

Healthcare facilities and providers would be well advised to review all of the recommendations — including, among others:

• prioritizing surgical/procedural care and high-complexity chronic disease management, and select preventive services that are highly necessary;

• establishing “Non-COVID Care” (NCC) zones, including screening all patients for COVID-19 symptoms and temperature checks;

• routinely screening healthcare and non-healthcare staff working in the NCC area, quarantining any who test positive;

• requiring healthcare providers and staff to wear surgical masks at all times, and for procedures with a high risk of aerosol transmission, using appropriate protection such as N95 masks and face shields;

• patients should wear a cloth face covering brought from home if they don’t have surgical masks;

• staff working in the NCC zones should not rotate into non-NCC zones (e.g., providers should not round in the hospital and come to an NCC care area);

• NCC zones should be separated from other areas to the extent possible (for example, in a separate building, designated floors or rooms with separate entrances and minimal crossover with COVID-19 areas);

• use controls for social distancing, such as limiting wait times, keeping patient volumes low, and spacing chairs at least 6 feet apart in waiting areas;

• prohibiting visitors unless needed for an aspect of patient care, and pre-screening any such visitors;

• utilizing appropriate sanitation procedures; and

• maintaining adequate supplies, while making sure volumes are available to respond to a COVID-19 surge.

Please refer to the CMS recommendations to review the complete list.