The Centers for Medicare & Medicaid Services (CMS) recently released Phase II recommendations to guide healthcare facilities as they reopen to provide non-emergent procedures unrelated to the 2019 novel coronavirus (COVID-19). In issuing the Phase II recommendations, CMS Administrator Seema Verma encouraged further reopening of healthcare facilities and suggested patients could be “confident seeking in-person care when recommended by their provider.”

The Phase II recommendations provide an update to CMS’ previously issued Phase I recommendations — released April 19, 2020, and discussed in McGuireWoods’ April 21, 2020, alert — and address only healthcare providers in those states and regions with no evidence of a rebound of COVID-19 and that meet certain gating criteria. While CMS encourages reopening, the extent of the guidance suggests a need to be cautious and thoughtful. In part, CMS states that extending non-emergent, non-COVID-19 medical services should be limited to areas and facilities that have both the necessary resources and the capacity to promptly respond to any significant increase in COVID-19 cases. Further, any reopening of healthcare facilities should be done in conjunction with state and local health officials and any applicable guidance. Providers should continue to utilize telehealth to the extent appropriate, and, if an individual is at high risk for COVID-19 and his or her condition does not warrant a face-to-face visit, then such person should remain at home.

CMS intends the non-binding Phase II recommendations to assist the healthcare community in restarting non-emergent, non-COVID-19 care if applicable criteria are met. While the Phase II recommendations are split into considerations such as testing, personal protective equipment and supplies, and sanitation protocols, healthcare providers should consider certain key points from CMS’ guidance as they seek to reopen:

1. Evaluate Ongoing COVID-19 Cases Within the Area. It is imperative that healthcare systems and providers retain their ability to handle COVID-19 cases in the event of a COVID-19 surge. Work with public health officials to stay on top of applicable local or regional metrics.
2. Evaluate the Necessity of Care. Providers should evaluate the necessity of the non-emergent care to be provided based on each patient’s clinical needs. Providers should first address services where a delay would be most likely to cause harm to the patient. Further, providers should focus on at-risk populations who are most in need of services and would benefit most. At-risk populations include individuals with serious underlying health conditions, those who are more likely to face complications without care and those without telehealth access.
3. Enhance Controls to Facilitate the Reduction of COVID-19. Healthcare facilities should take steps to separate spaces that serve non-emergent healthcare needs from spaces that treat COVID-19-related illness. Potential approaches to facilitate this separation include the use of designated floors, rooms or buildings with separate entrances from areas that provide care to COVID-19 patients. Ideally, staff and supplies will not be shared by both non-emergent patients and COVID-19 patients. All providers and staff should wear surgical masks when providing non-emergent patient care. However, N95 respirators and face shields may be necessary for non-COVID-19 procedures involving the mucous membranes.
4. Address Entrance Considerations. Facilities should take steps to create and support social distancing, such as limiting patient time in waiting areas and restricting patient volumes. Visitor access should be restricted, and visitors should be screened for COVID-19 symptoms when they arrive and should wear a mask or other face-covering inside the facility.
5. Staff and Patients Should Be Screened and Tested. Patients should be tested for COVID-19 in advance of their planned procedures, if possible. If that test comes back positive, then the clinical team must evaluate whether to go ahead with the procedure, which would occur in a COVID-19 area. Healthcare facilities should screen staff when they arrive at work each day, and staff with symptoms should receive a COVID-19 test and be sent home to comply with care and quarantine procedures. In addition, if a staff member will be working with non-COVID-19 patients, then he or she should remain working with such individuals unless it is absolutely necessary to move such person into a COVID-19 area.
6. Clearly Outline and Implement Sanitation Protocols. Areas to be used for non-COVID-19 patients must be cleaned and disinfected completely prior to use, and any equipment that will be used for both COVID-19 patients and non-emergent, non-COVID-19 patients should be meticulously disinfected in accordance with national guidelines.
7. Take Extra Precautions for High-Risk Patients. Providers need to take special care with high-risk patients that begins with a personalized care plan to address unplanned care, among other considerations. It is best to limit in-person care as much as possible through telemedicine, but if an in-person visit is required, then healthcare providers should take steps to limit exposure. This includes allowing such patients to remain in their vehicles until the appointment and ensuring that they wear masks. Special considerations extend to healthcare providers who need to enter the same home or space as a high-risk person, which will entail following government guidelines and social distancing.
8. Review and Share With Patients CMS’ Comparable Patient Guide. In encouraging healthcare providers to reopen, CMS also issued, for patients seeking healthcare, a new patient guide that is consistent with its provider guidance. A provider could share this guide with patients to increase their comfort in seeking non-emergent care. In this guide, CMS encourages patients to consider telehealth visits but to seek necessary care, including in-person visits when warranted, and to expect certain changes in care protocols, including masks, hand-washing and visitor restrictions.