NEW CMS EMERGENCY
PREPAREDNESS RULE
Focus on Home Health Agencies and Hospice Care
WHAT IS THE NEW CMS RULE?
Purpose: To establish national emergency preparedness requirements,
consistent across provider and supplier types.
•
Outlines emergency preparedness Conditions of
Participation (CoPs) & Conditions for Coverage (CfCs)
- CoPs and CfCs are health and safety standards all
participating providers must meet to receive
certificate of compliance
•
Applies to 17 provider and supplier types
- Different emergency preparedness regulations for
each provider type
Bottom line: Providers and Suppliers that wish to participate in Medicare and
Medicaid – i.e. the nation’s largest insurer – must demonstrate they meet new
emergency preparedness requirements in rule.
HOW WILL THE CMS RULE BE ENFORCED?
November 15, 2017- surveying for compliance
begins
 Same enforcement process as with any other
health and safety standard in the Condition of
Participation or Conditions for Coverage. *
 These new regulations are a condition or
requirement of participation in
Medicare/Medicaid

*Title XVIII of the Social Security Act
will rule
be audited?
AHow
UDITING
AND
• Compliance monitoring
ENFORCEMENT
State Survey Agencies (SSAs)
Accreditation Organizations (AOs)
CMS Regional Offices (ROs)
Use IGs and
State
Operations
Manual
• Checklists for surveyors and State Agencies, as well as for
impacted providers and suppliers are in development.
• SCG developing web-based training for surveyors and providers
and suppliers .
Consequence for not complying?
• Same process for other CoPs and CfCs  termination
of agreement with Medicare & Medicaid.
4
FOUR CORE ELEMENTS OF CMS RULE
Emergency Plan
•Based on a
risk
assessment
•Use an allhazards
approach to
risk
assessment
•Update plan
annually
Policies &
Procedures
•Develop based
on risk
assessment and
emergency plan
•Must address:
subsistence of staff
and patients,
evacuation,
sheltering in place,
tracking patients
and staff
•Review/Update
annually
Communications
Plan
Training & Exercise
Program
•Complies with
Federal and State
laws
•Develop training
program, including
initial training on
policies &
procedures
•Train annually
•Coordinate patient
care within facility,
across providers,
and with state and
local public health
and emergency
management
•Annual update
•Conduct drills and
exercises: FullScale community
based exercise
annually and
additional exercise
for some facility
types
WHAT IS NEW? HOME HEALTH
Annual Hazard Vulnerability Assessment
 Annual Full Scale exercise that is community based
 Additional Exercise- Tabletop
 Individual plan for each patient completed as part of
comprehensive patient assessment
 Tracking patients and reporting status and needs to
local emergency service providers during disasters
 Inform local emergency services of any on-duty staff
or patients unable to contact
 Train volunteers and those under service contracts annually
 Name & contact information for volunteers
 Integrated Healthcare System

WHAT'S NEW? HOSPICE
Annual Hazard Vulnerability Assessment
 Annual Full Scale exercise that is community based
 Additional Exercise- Tabletop
 Policies to address:

Shelter in Place
 Evacuation

MOU with other hospices and other providers to
receive patients during an evacuation
 Tracking patients and on-duty staff, reporting status
and needs, including evacuation to local emergency
service providers during disasters
 Integrated Healthcare System

DEVELOP EMERGENCY PLAN, POLICIES,
AND PROCEDURES
Conduct a facility specific hazard assessment or
“HVA”
1.
Community specific hazards in area (flood, earthquake)
 Facility hazards (utilities, cyber attacks)

2.
3.
Develop policies and procedures that address the
identified risks/hazards
Review and update policies and procedures
annually
HAZARD VULNERABILITY ANALYSIS “HVA”
Natural
Technological
Human
Hazardous Materials
Real alerts or events are recorded on one tab of the Excel sheet. Results of
all real and assessed risk information roll up into a “top 10” final report
ANNUAL EXERCISE REQUIREMENTS

Conduct one FULL SCALE EXERCISE annually
Participate in a community based exercise
 Actual events count but you MUST DOCUMENT


Conduct an additional exercise of the facility’s
choice - can be a tabletop exercise
Bottom line: More staff time will be needed
to conduct an annual full-scale exercise
WHAT IS A FULL SCALE EXERCISE
Activating plans
Moving people
and equipment
Staff
participation
to
demonstrate
knowledge of
emergency
procedures
We will help you
understand how to do a
full-scale exercise!
Full Scale Exercise
REAL LIFE EVENT CAN BE USED INSTEAD OF
EXERCISE


If your facility experiences an actual natural or manmade emergency or disaster that requires activation
of the emergency plan
Annual requirement for testing is not measured by
calendar year but will be measured from the date of
the last actual emergency event or the date the
exercise/testing took place
DOCUMENTATION: MAKE IT COUNT
Exercise or real event must be documented
 Remember to include:

After Action Report /Improvement Plan
 Photos
 Sign-in Sheets
 Forms used during exercise or event
 Updates to your emergency plan
 Letter from county’s Disaster Healthcare Coalition

DOCUMENTATION OF
EXERCISE PARTICIPATION AND
COORDINATION
NEWS FROM CMS….
ADDITIONAL EXERCISE- TABLETOP
Tabletop exercise includes a group discussion led
by a facilitator
 Uses a narrated, clinically relevant emergency
scenario
 Participants answer questions based on a
scenario and your emergency plan


Earthquake, active shooter, internal fire/flood,
evacuation, etc.
ALTERNATE SOURCE OF ENERGY- HOSPICE

Alternate source of energy to:





Maintain Temperature
Safe and sanitary storage of provisions
Emergency lighting
Fire detection extinguishing and alarms
Sewage and waste disposal

Link to full rule and pull it up to look at
HOW CAN WE HELP YOU?

Meet exercise requirements- Full-scale and tabletop
exercise


November disaster exercise
Attend Coalition meetings!

Learn how to do your HVA- Today April 20th

And other topics throughout the year

Ask us to review your facility’s emergency plan

Resources for tabletops, plan development and more!
HOW DO I LEARN MORE ABOUT THE REQUIREMENTS?
Participate in Webinars/Attend trainings
 Participate in Santa Barbara’s Disaster
Healthcare Coalition
 Read the FAQ’s on CMS webpage:

https://www.cms.gov/medicare/provider-enrollment-andcertification/surveycertemergprep/emergency-preprule.html
HOW DO I LEARN MORE ABOUT THE CMS REQUIREMENTS?




REGISTER TODAY for the CMS MLN
Webinar on Thursday, April 27, 2017 Time: 2:30-3:30
PM EST . The focus of the webinar is on Training and
Testing Requirements. Click link below for details about
the webinar and to register today, seats are limited.
https://www.cms.gov/Medicare/Provider-Enrollment-andCertification/SurveyCertificationGenInfo/Downloads/Surve
y-and-Cert-Letter-17-22.pdf
CMS Training and Testing Clarification Letter-see link below.
https://www.cms.gov/Medicare/Provider-Enrollment-andCertification/SurveyCertificationGenInfo/Downloads/Surve
y-and-Cert-Letter-17-21.pdf