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New guidelines help provide roadmap for health care facilities resuming elective/non-urgent procedures

After nearly two months of rolling shutdowns in response to the COVID-19 pandemic, businesses across all industries are preparing or beginning to resume operations in ways that prioritize the health and safety of the public and their workforce.

Following the March 18 recommendation by the Centers for Medicare and Medicaid Services (CMS) to limit non-essential health care services to ensure sufficient capacity and supplies to care for COVID-19 patients, most health care providers in Idaho temporarily suspended all non-urgent and elective medical treatment.

With COVID-19 case numbers beginning to stabilize in some parts of the country, CMS issued new recommendations on April 19 to guide health care providers in resuming elective and non-urgent medical procedures. Health care facilities can use the following guidelines to safeguard the health and safety of patients and staff while also reducing the risk of community spread and COVID-19 case surges.

State and Local Concerns:

  • Comply with state and local orders and recommendations. These decisions consider both disease prevalence and resource limitations that can impact the public.
  • Actively coordinate with the Idaho Public Health Districts in your area (Panhandle, North Central, Central, Eastern, Southwest, South Central, Southeastern) for COVID-19 case tracking and reporting.
  • Monitor community prevalence of COVID-19 and be prepared to decrease or stop non-essential treatment in the event of a surge in cases.

Patient Management:

  • Train staff on communicating with patients about COVID-19 and related safety protocols. COVID-19 has created an atmosphere of patient uncertainty and fear, so staff should be prepared to address patient concerns through effective communication and education.
  • Develop policies that prioritize elective procedures based upon medical necessity and risk to the patient.
  • When appropriate, use telehealth to minimize the risk of exposure and asymptomatic spread and to reduce the use of personal protective equipment (PPE).
  • Screen patients for COVID-19 risk factors prior to in-person appointments.
  • Stay up to date on the Centers for Disease Control and Prevention (CDC) and community recommendations to ensure care is consistent with applicable standards.
  • Consider updating patient consent forms. For some medical treatments, COVID-19 may pose a risk that should be disclosed to the patient in advance of medical care.

Infection Prevention:

  • Modify premises to optimize social distancing, including installation of physical barriers and development of intentional traffic patterns.
  • Adjust scheduling patterns to reduce the number of patients present at any particular time and to limit non-essential visitors.
  • Review cleaning and disinfecting protocols to ensure compliance with infection prevention recommendations specific to COVID-19.
  • Post visual alerts to remind individuals how to practice appropriate infection control measures and provide supplies for compliance (e.g., hand sanitizer, face masks).

Personal Protective Equipment:

  • Require staff to wear face masks at all times.
  • Request patients wear a face mask or a cloth face covering.
  • Retrain staff on appropriate selection and use of PPE.
  • If PPE is in short supply, conserve its use consistent with recommendations by CDC.

Health Care and Facility Staff:

  • Screen staff daily for symptoms or potential exposure. Employers can implement the employee screening protocols published by the Equal Employment Opportunity Commission (EEOC) and use the CDC’s risk assessment guide to inform work restriction decisions.
  • Implement return-to-work requirements consistent with the CDC’s criteria for confirmed or suspected COVID-19 illness, which may include testing or work exclusion requirements.
  • Prioritize testing for health care providers with suspected COVID-19 to ensure timely disease mitigation and minimize unnecessary restrictions. Always be mindful of HIPAA implications in sharing/obtaining such information.
  • Modify sick leave policies to ensure they are flexible and non-punitive and allow staff to comply with public health guidance related to self-isolation.
  • Develop a plan for staffing shortages due to illness or exposure, which may include waiving certain return-to-work criteria. Consider the CDC’s recommendations for mitigating staff shortages.

Facility Management:

  • Ensure adequate equipment, medications and supplies for operations; but be mindful that acquiring these items does not limit supplies for those health care providers responding to and treating COVID-19 patients.
  • Evaluate insurance coverage to ensure professional liability limits are appropriate.
  • Update billing and coding procedures to be consistent with new guidelines, including introduction of new codes for COVID-19-related treatment and telehealth.
  • Review existing contracts with employees, contractors and vendors. Terms to revise may include schedules, expectancies and compensation as well as the addition of requirements for anyone on-site to implement COVID-19 safeguards.
  • For facilities that accepted COVID-19 stimulus funds, ensure compliance with Department of Health and Human Services terms and conditions. Be sure to maintain robust documentation related to allocations and expenditures of those funds.
  • Before relying on a federal or local regulatory waiver, confirm whether the waiver is still in effect — as many are effective only during the public health emergency. Also, maintain robust documentation of any reliance on a waiver.

Implementing these guidelines at your health care facility can have a notable impact on reducing the risk of exposure to, or asymptomatic spread of, COVID-19.

Lisa Carlson is an associate at Holland & Hart. She helps clients navigate the complex regulatory, compliance and litigation challenges of today’s evolving health care law landscape.

About Lisa Carlson