CMS Recommendations: Re-opening Facilities to Provide Non-emergent Non-COVID-19 Healthcare

As states and localities begin to stabilize, CMS recognizes the importance to restart care that is currently being postponed, such as surgeries and procedures, chronic disease care, and preventive care. As states and regions pass the Gating Criteria (symptoms, cases, and hospitals) and proceed to Phase 1, CMS created recommendations aimed to give healthcare facilities some flexibility in providing essential non-COVID-19 care to patients without symptoms of COVID-19 in regions with a low incidence.

General Considerations

  • In coordination with the State and local public health officials, analyze the incidence and trends for COVID-19.
  • Evaluate the necessity of care based on clinical needs.
    • Providers should prioritize surgical/procedural care and high-complexity chronic disease management.
    • Select preventive services may also be highly necessary.
  • Establish non-COVID Care zones (NCC) that would screen all patients for symptoms of COVID-19.
  • Sufficient resources should be available to the facility across phases of care.
    • PPE, a healthy workforce, facilities, supplies, testing capacity, and post-acute care.

Personal Protective Equipment

  • CMS recommends that healthcare providers and staff wear surgical facemasks at all times.
  • Staff should utilize appropriate respiratory protection such as N95 masks and face shields for the respiratory tract.
  • Patients should wear a cloth face covering that can be bought or made at home.
  • Every effort should be made to conserve personal protective equipment. Guidance can be found here: https://www.cdc.gov/coronavirus/2019-ncov/hcp/ppe-strategy/index.html

Workforce Availability

  • Staffing levels in the community must remain adequate to cover a potential surge in CVOID-19 cases.
  • Staff should be routinely screened for symptoms of COVID-19.

Facility Considerations

  • The facility should create areas of NCC which have in place steps to reduce risk of COVID-19 exposure and transmission; these areas should be separate from other facilities to the degrees possible (i.e., separate building, or designated rooms or floor with a separate entrance and
    minimal crossover with COVID-19 areas).
  • Established social distancing, such as minimizing time in waiting areas, spacing chairs at least 6 feet apart, and maintaining low patient volumes.
  • Visitors should be prohibited, but if needed, they should be pre-screened in the same way as a patient.

Sanitation Protocols

  • Ensure that there is an established plan for thorough cleaning and disinfection before using spaces or facilities.
  • Ensure that equipment such as anesthesia machines used for COVID-19 (+) patients are thoroughly decontaminated.

Supplies

  • Adequate supplies of equipment, medication, and supplies must be ensured.

Test Capacity

  • All patients must be screened for potential symptoms of COVID-19 before entering the NCC facility, and staff must be routinely screened.
  • When the adequate testing capability is established, patients should be screened by laboratory testing before care, and staff working in these facilities should be regularly screened by laboratory tests.

Sources: Centers for Medicare & Medicaid Services (CMS)

 

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