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:
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
Please contact the authors for additional information regarding these new
CMS recommendations and their impact on reopening or increasing provision
of non-elective procedures. Healthcare providers may also want to consider
guidance provided by McGuireWoods as
provider platforms reopen. McGuireWoods has also published additional thought leadership related to how companies across various
industries can address crucial COVID-19-related business and legal issues.
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In a series of video alerts, McGuireWoods’ healthcare lawyers address
issues providers face and overcoming COVID-19 challenges.
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