CMS Releases New Interpretive Guidance on Emergency Preparedness

The Centers for Medicare and Medicaid Services (CMS) has revised requirements for emergency preparedness for all providers and issued new Interpretive Guidance, Appendix Z. The guidance addresses a number of requirements, including emergency plans and the review of those plans as well as training related to emergency plans and the testing of those plans.

Per an analysis by LeadingAge National, highlights of the changes include the following:

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 it 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 it 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 two training exercises annually. In the September 2019 final rule, CMS revised requirements based on types of providers (inpatient versus 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 two training exercises annually. One of the two 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 is an exercise of choice and may include a community-based full-scale exercise, an individual facility-based functional exercise, a drill, or a tabletop 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 (PACE), home health agencies, comprehensive outpatient rehabilitation facilities, organizations (such as clinics, rehabilitation agencies, and 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 one training exercise annually. The exercise must be a full-scale community-based exercise or individual facility-based functional exercise and be held at least every other year. On off years, the provider may conduct an exercise of choice, which may include a community-based full-scale exercise, an individual facility-based functional exercise, a drill, or a tabletop 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.

Additional resources for emergency preparedness can be found on the CMS website.

Contact: Elliott Frost, efrost@leadingageny.org, 518-867-8832