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September 28, 2016
Earlier this month, the Centers for Medicare & Medicaid Services (CMS) finalized a rule to establish consistent emergency preparedness requirements for healthcare providers participating in Medicare and Medicaid, increase patient safety during emergencies and establish a more coordinated response to natural and man-made disasters. Healthcare providers and suppliers affected by this rule must comply with and implement all regulations one year after the effective date of November 15, 2016.
Indication of Need for Expanded Requirements
After reviewing the current Medicare emergency preparedness regulations for both providers and suppliers, CMS found that regulatory requirements were not comprehensive enough to address the complexities of emergency preparedness. For example, the requirements did not address the need for: (1) communication to coordinate with other systems of care within cities or states; (2) contingency planning; and (3) training of personnel. CMS proposed policies to address these gaps in the proposed rule, which was open to stakeholder comments.
In the final rule, CMS states that the emergency preparedness requirements will be consistent and enforceable for all affected Medicare and Medicaid providers and suppliers, and address the three key essentials they believe are necessary for maintaining access to healthcare services during emergencies: safeguarding human resources, maintaining business continuity and protecting physical resources.
“Situations like the recent flooding in Baton Rouge, Louisiana, remind us that in the event of an emergency, the first priority of healthcare providers and suppliers is to protect the health and safety of their patients,” said Patrick Conway, MD, MSc, CMS deputy administrator and chief medical officer. “Preparation, planning and one comprehensive approach for emergency preparedness is key.”
“As people with medical needs are cared for in increasingly diverse settings, disaster preparedness is not only a responsibility of hospitals, but of many other providers and suppliers of healthcare services. Whether it’s trauma care or long-term nursing care or a home health service, patients’ needs for healthcare don’t stop when disasters strike; in fact, their needs often increase in the immediate aftermath of a disaster,” said Nicole Lurie, MD, Health and Human Services assistant secretary for preparedness and response. “All parts of the healthcare system must be able to keep providing care through a disaster, both to save lives and to ensure that people can continue to function in their usual setting. Disasters tend to stress the entire healthcare system, and that’s not good for anyone.”
This final rule requires Medicare and Medicaid participating providers and suppliers to meet the following four common industry best practice standards:
- Risk assessment and emergency plan: The rule requires facilities to perform a risk assessment that uses an “all-hazards” approach prior to establishing an emergency plan. The all-hazards risk assessment will be used to identify the essential components to be integrated into the facility emergency plan. An all-hazards approach is an integrated approach to emergency preparedness planning that focuses on capacities and capabilities that are critical to preparedness for a full spectrum of emergencies or disasters. This approach is specific to the location of the provider or supplier and considers the particular types of hazards most likely to occur in their areas. These may include, but are not limited to, care-related emergencies; equipment and power failures; interruptions in communications, including cyber-attacks; loss of a portion or all of a facility; and interruptions in the normal supply of essentials, such as water and food.
- Policies and procedures: Develop and implement policies and procedures based on the emergency plan and risk assessment.
- Communication plan: Develop and maintain a communication plan that complies with both federal and state law. Patient care must be well-coordinated within the facility, across healthcare providers, and with state and local public health departments and emergency systems.
- Training and testing program: Develop and maintain an emergency preparedness training and testing program, which must include initial training for new and existing staff in emergency preparedness policies and procedures as well as annual refresher trainings. The facility must offer annual emergency preparedness training so that staff can demonstrate knowledge of emergency procedures. The facility must also conduct drills and exercises to test the emergency plan to identify gaps and areas for improvement.
The new rule is aimed at preventing the severe breakdown in patient care that followed recent disasters, while also strengthening the ability to provide services during other types of emergencies, such as pandemics and terrorist attacks. The rule is unusual in that it has provisions for 17 different provider types, among them those that patients rely on to live at home, such as outpatient surgery sites, physical therapy offices and home health agencies.
Barbara B. Citarella, the president of RBC Limited, a healthcare consulting group in Staatsburg, N.Y., expressed concern that the requirements may be particularly onerous for smaller facilities. “My concern is that compliance for some providers, especially home care and hospice, will be financially impossible.”
The final requirements acknowledged those concerns, but argued that preparedness investments would be beneficial overall. “Planning for the protection and care of patients, clients, residents and staff during an emergency or a disaster is a good business practice,” the rule said.
CMS estimated the requirements will affect approximately 73,000 providers and suppliers and cost them a total of about $280 million to comply. Providers that do not comply with the requirements could risk losing Medicare and Medicaid reimbursements.