Revisions and Interpretive Guidance for Emergency Preparedness Requirements
In a burden reduction rule finalized in September 2019, CMS revised requirements for emergency preparedness for all providers. These requirements impact providers across the LeadingAge membership including hospital- and community-based hospices, home health agencies, Programs for All-Inclusive Care for the Elderly (PACE), and nursing homes, including nursing homes that are part of a Life Plan Community.
The rule also applies to a number of other health care providers including hospitals, psychiatric residential treatment facilities, intermediate care facilities for individuals with intellectual disabilities, critical-access hospitals, ambulatory surgical centers, comprehensive outpatient rehabilitation facilities, community mental health clinics, rural health clinics, federally qualified health centers, end-stage renal disease facilities, organ procurement organizations, and other organizations such as clinics, rehabilitation agencies, and public health agencies as providers of outpatient physical therapy and speech-language pathology services.
Revised requirements went into effect November 29, 2019. CMS released interpretive guidance on these requirements December 20, 2019. What follows below is an analysis of the final rule as it applies to different provider types.
Requirements for Emergency Plans
Prior to this rule, providers were required to document efforts to contact local, tribal, regional, state, and federal emergency preparedness officials in emergency planning. All providers continue to be required to have a process for cooperation and collaboration with these entities as part of the emergency plan in order to maintain an integrated response during disaster, but providers are no longer required to document efforts to contact these entities in emergency planning.
Requirements for Review of Emergency Program
Previously, providers were required to review the emergency program on an annual basis. Long-term care providers (nursing homes) continue to be required to review the emergency program on an annual basis. All other providers are now required to review this program only biennially. CMS notes that all providers, including long-term care providers, should review and update the plan as necessary to ensure that the plan is operating on best practices. Examples of when a review may be required more frequently would include changes to the emergency program or plan due to staffing changes or lessons learned from a real-life event or exercise.
Requirements for Training on Emergency Program and Plan
Originally, providers were required to train all staff on the emergency program initially and on an annual basis thereafter. All providers must continue to provide initial training to all staff on the emergency program. Long-term care providers must continue to provide additional training on an annual basis thereafter, while all other providers are now required to provide additional training only biennially. All providers, including long-term care providers, must also provide additional training when significant changes or updates have been made to the emergency plan.
Requirements for Testing of Emergency Plan
Previously, all providers were required to conduct 2 training exercises annually. In the September 2019 final rule, CMS revised requirements based on types of providers (inpatient vs. outpatient) and clarified types of exercises.
Inpatient providers include inpatient hospice facilities, psychiatric residential treatment facilities, hospitals, long-term care facilities, intermediate care facilities for individuals with intellectual disabilities, and critical-access hospitals. Inpatient providers must continue to conduct 2 training exercises annually. One of the 2 required exercises must be a full-scale community-based exercise. If a community-based exercise is not available, the exercise may be an individual facility-based exercise. The second exercise may be an exercise of choice to include a community-based full-scale exercise, an individual facility-based functional exercise, a drill, or a table-top exercise or workshop with group discussion led by a facilitator.
Outpatient providers include ambulatory surgical centers, freestanding/home-based hospice, Programs of All-Inclusive Care for the Elderly, home health agencies, comprehensive outpatient rehabilitation facilities, organizations (such as clinics, rehabilitation agencies, public health agencies as providers of outpatient physical therapy and speech-language pathology services), community mental health centers, organ procurement organizations, rural health centers, federally-qualified health centers, and end-stage renal disease facilities. Outpatient providers are now required to conduct only 1 training exercise annually. The exercise must be a full-scale community-based exercise or individual facility-based functional exercise at least every other year. On off years, the provider may conduct an exercise of choice to include a community-based full-scale exercise, an individual facility-based functional exercise, a drill, or a table-top exercise or workshop with group discussion led by a facilitator.
CMS stresses that when required, providers should attempt to conduct full-scale exercises in the community. If a full-scale community-based exercise is not available, a provider may conduct a functional exercise at an individual facility-based level but a drill will not satisfy this requirement. Also note that when a provider experiences an actual natural or man-made emergency that requires activation of the emergency plan, the provider is exempt from engaging in its next required full-scale community-based or facility-based functional exercise following the onset of the emergency event.
For reference, CMS has specified that a full-scale exercise is a multi-agency, multi-jurisdictional, multi-discipline exercise involving functional (for example, joint field office, emergency operations centers, etc.) and “boots on the ground” responses (for example, fire fighters decontaminating mock victims).
A functional exercise is an exercise that examines or validates the coordination, command, and control between various multi-agency coordination centers (for example emergency operation center, joint field office, etc.). A functional exercise does not involve any “boots on the ground” (that is, first responders or emergency officials responding to an incident in real time).
In addition to the resources available on the CMS website, CMS directs providers to additional resources from Health and Human Services and Homeland Security.