The Centers for Medicare and Medicaid Services issued guidelines Sunday to assist hospitals in safely resuming elective surgeries, as a number of states consider allowing non-emergency procedures as part of their plans to reopen the economy and pull back COVID-19 restrictions.

CMS is recommending that non-COVID-19 care be offered “as clinically appropriate” within a state, locality, or facility equipped with resources to provide such care and where providers can quickly respond to surges in COVID-19 cases, if necessary.

“Decisions should be consistent with public health information and in collaboration with state public health authorities,” said the U.S. agency in its guidelines. “Careful planning is required to resume in-person care of patients requiring non-COVID-19 care, and all aspects of care must be considered.”

Guidelines call for the availability of adequate facilities, testing and supplies, as well as adequate workforces of clinicians, nurses, anesthesia, pharmacy workers, imaging specialists, pathology support, and post-acute care. Staff should be routinely screened for COVID-19, with those showing symptoms tested and quarantined.

Healthcare systems are encouraged to work with state and local officials to evaluate incidences and trends of COVID-19 in areas where resuming in-person care is being considered, and to evaluate the necessity of care based on clinical needs, with surgical/procedural care and high-complexity chronic disease management prioritized. They should also set up NON-COVID Care (NCC) zones to screen all patients for symptoms, including temperature checks.

Adequate supplies of equipment and resources for PPE, healthy workforces, facilities, supplies, testing capacity, post-acute care and other phases of care must be ensured without interfering with surge capacity. In addition, face coverings such as surgical face masks should be worn by providers and staff at all times, and protocols for sanitation and decontamination of equipment, social distancing, and adequate testing capability should be in place.

State governors are setting their sights on reopening their individual economies, in accordance with a three-phase plan released last week by the Trump administration. The first phase calls for outpatient elective operations to resume, followed by inpatient elective procedures in the second phase. Exercising it lies with the discretion of each state government.

Among them is Texas, where Governor Greg Abbott issued an executive order Friday to loosen restrictions put in place back in March on surgeries.

"We have shown that Texas can continue our efforts to contain COVID-19 while also adopting safe standards that will allow us to begin the process of reopening Texas,” said Abbott in a press conference.

Others include Alaska, which has mandated non-urgent procedures that cannot be delayed beyond eight weeks to resume on May 4; and Oklahoma, which is allowing providers to determine when elective surgeries can resume, starting April 24.

The American Hospital Association also released its own set of principles for resuming elective procedures, in conjunction with the American College of Surgeons (ACS), American Society of Anesthesiologists (ASA), Association of periOperative Registered Nurses (AORN). Among their guidelines are for health systems to cautiously determine the right time to restart operations, and ensure there is access to adequate equipment, testing, COVID-19 data assessment, COVID-19 safety and risk mitigation, and prioritization and scheduling.

“When the first wave of this pandemic is behind us, the pent-up patient demand for surgical and procedural care may be immense, and health care organizations, physicians and nurses must be prepared to meet this demand,” they said in a joint statement.