On April 19, 2020, the Centers for Medicare & Medicaid Services (CMS) issued Phase 1 of recommendations for re-opening certain healthcare facilities that provide non-emergent healthcare following COVID-19 related non-essential business closures. Previously, CMS recommended limiting non-essential medical and surgical procedures to preserve personal protective equipment, beds, and ventilators that could be used for those providing essential COVID-19 related healthcare. The Phase 1 recommendations recognize that flexibility to provide non-emergent healthcare is needed in areas with low, relatively low, and stable incidences of COVID-19. Phase 1 will enable healthcare facilities and clinicians to provide clinically necessary care to patients with non-COVID-19 needs or complex chronic disease management.

Phase 1 requires that states or regions must first pass the Gating Criteria that were announced on April 16, 2020.

• Symptoms: Downward trajectory of influenza-like illnesses (ILI) reported within a 14-day period AND downward trajectory of COVID-like syndromic cases reported within a 14-day period.
• Cases: Downward trajectory of documented cases within a 14-day period OR downward trajectory of positive tests as a percent of total tests within a 14-day period (flat or increasing volume of tests).
• Hospitals: Treat all patients without crisis care AND robust testing program in place for at-risk healthcare workers, including emerging antibody testing.

Once these Gating Criteria are passed, states or localities can begin to plan to re-start non-COVID-19 related non-emergent care, such as procedural care (surgeries and procedures), chronic disease care, and, ultimately, preventive care. A number of factors must be planned for and addressed prior to re-starting care.

• Healthcare facilities must have sufficient equipment, supplies, and medication to treat non-COVID-19 related patients as well as be able to cover any surges in COVID-19 cases.
• Facilities should establish Non-COVID Care (NCC) zones to treat non-COVID-19 related patients and must screen all patients for COVID-19 prior to allowing admission.
• Staffing levels must be able to cover potential COVID-19 surges and all healthcare providers and staff must wear masks and undergo routine COVID-19 screening.
• Patients should wear cloth face coverings.
• Social distancing practices should be maintained, including spacing chairs six feet apart in waiting areas and limiting non-patient visitors.
• Spaces should be thoroughly cleaned and disinfected.

CMS recommends that all healthcare facilities that choose to restart non-emergent care continually reevaluate whether their state or locality meets the Gating Criteria and adjust business operations accordingly. CMS will issue additional Phases of recommendations for re-opening in the future.