As certain areas of the country are beginning to see a downturn in new and active cases of COVID-19, many are eager to start the process of re-opening as regions start to stabilize. Last week, the White House issued a three-phase approach to states on reopening the economy based on ‘gating criteria’ which assess the number of COVID-19 cases and symptoms over a 2-week period of time and hospital’s testing and patient care capabilities.  The Centers for Medicare and Medicaid Services (CMS) has since released new recommendations, aligned with the phased in approach, for the reopening of facilities to provide non-emergent, non-COVID care.

Three-Phase Approach

Following the federal guidelines is not mandatory for the states.  However, the administration strongly encourages states to evaluate their plan, based on the advice of healthcare experts, and tailor it to their regional situations. The recommendations begin with a state achieving the following ‘gating criteria’ sustained over two weeks:

  • Symptoms – Show a downward trajectory of influenza-like illnesses reported within a 14-day period AND show a downward trajectory of COVID-like syndromic cases reported within a 14-day period.
  • Cases – Show a downward trajectory of documented cases within a 14-day period OR show a downward trajectory of positive tests as a percent of total tests within a 14-day period (flat or increasing volume of tests).
  • Hospitals – Be able to treat all patients without crisis-care and have robust testing in place for at-risk healthcare workers which includes anti-body testing.

If a state is following the administration’s recommendations, they must first satisfy the above criteria to begin the first phase of reopening. A state would then continue to meet the ‘gating criteria’ for a second and then third time in order to move on to the other two phases. The recommendations for employers and healthcare systems for each phase are:

  • Phase 1Employers should continue to encourage telework when possible and return employees to work in phases, common areas should be closed if possible or strict social distancing should be enforced, non-essential travel should be minimized, and making special accommodations for vulnerable employees is strongly recommended. Healthcare facilities can resume elective surgeries and procedures, as clinically appropriate, on an outpatient basis that adhere to CMS guidelines.
  • Phase 2Employers should follow the same guidelines as the first phase but may loosen restrictions on traveling and social distancing within the workplace. Healthcare facilities can resume elective surgeries and procedures, as clinically appropriate, on both an outpatient and in-patient basis while still adhering to CMS guidelines.
  • Phase 3 Employers can resume unrestricted staffing of worksites. Healthcare facilities can resume normal operations, including allowing visitors into hospital sites.

The administration has released a new Opening Up America Again website with further details, available HERE.

CMS Guidelines

Following the federal guidelines, a state in phase 1 can have healthcare facilities begin transitioning back to non-COVID care under CMS’s new guidance. When considering resuming non-essential services, CMS recommends reviewing the availability of personal protective equipment (PPE) and other supplies, along with workforce availability, facility readiness, testing capacity and aligning with state public health authorities. General considerations include prioritizing high-complexity or chronic disease patients and establishing ‘Non-COVID Care’ zones which require screening for symptoms before entering. CMS stresses the importance of careful planning when resuming non-COVID patient care and that facilities should continue to evaluate whether a region remains low-risk and be prepared to cease non-essential operations in the case of a surge. The full guidelines are available HERE.

Some States Ready to Start

Prior to the release of the reopening guidelines, some states had already announced their own plans to start lifting restrictions in the coming weeks. Ultimately, it remains up to the Governor’s to determine when and how their state will reopen. At this time, Kentucky is the only state that has stated they’d be following the federal guidelines, however many other states have announced using a ‘phased in’ approach. With many states stay at home orders expiring in the next two weeks, most still need to release additional details on how the process will work.

As always, ADVOCATE will continue to keep you informed on the issues impacting medical groups as they develop.


Kayley Jaquet

Manager of Regulatory Affairs