Navigating CMS Emergency Preparedness Rule: Criteria, Compliance, and Essentials

1. Understanding the CMSEmergency PreparednessRule

2. Agenda • Overview of therule • Timeline • Audit and enforcement • CMS costestimations • Resources 4

3. Overview: CMS Emergency PreparednessRule

4. Origins of therule • Longtimecoming… • Call to action following 9/11, Hurricanes Katrina and Sandy, Ebola,Zika • Breakdowns in patientcare • Inconsistentstandards • Inconsistent levels ofpreparedness • Debate on incentivizing vs. mandating preparedness

5. What itis Purpose: To establish national emergency preparedness requirements, consistent across provider and suppliertypes. • 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 suppliertypes • Different emergency preparedness regulations for each providertype 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 inrule.

6. Who does it applyto?

7. Four coreelements • EmergencyPlan • Based on arisk assessment • Using an all- hazardsapproach • Communications Plan • Complies with Federal andState laws • Training &Exercise Program • Develop training program, including initial training on policies & procedures • Policies & Procedures • Based on risk assessmentand emergencyplan • Must address: subsistence ofstaff and patients, evacuation, sheltering in place, tracking patients andstaff • Coordinatepatient care within facility, acrossproviders, • and with stateand local public health and emergency management • Updateplan • annually • Conduct drillsand exercises

8. Risk Assessment and Emergency Plan • Perform a risk assessment using an “all-hazards” approach • Develop an emergency plan based on the risk assessment • Update emergency plan at leastannually

9. Policies andProcedures • Develop and implement policies and procedures based on the emergency plan, risk assessment, and communicationplan • Policies and procedures must address a range of issues including: • Subsistenceneeds, • Evacuation and shelter in placeplans, • Tracking patients and staff during anemergency, • Medical documentation,and; • Processes to develop arrangements with otherproviders/suppliers. • Review and update policies and procedures at leastannually

10. CommunicationPlan • Develop a communication plan that complies with both Federal and Statelaws • Coordinate patient care within the facility, across healthcare providers, and with state and local public health departments and emergency management systems. Toinclude: • Contact information for staff, entities providing services under other arrangements, patients’ physicians, other hospitals, andvolunteers • Maintaining contact info for regional or local emergency preparedness agencies • A means, in the event of evacuation, to release patientinformation • Review and update planannually

11. Training and TestingProgram • Develop and maintain training and testing programs. Toinclude: • Initial training on emergency preparedness policiesand • procedures. • Training to all new and existing staff, including volunteers and maintain documentation oftraining. • Demonstrate staff knowledge of emergency procedures and provide training at leastannually • Conduct drills and exercises to test the emergency plan • – Hospitals and most other provides must conductonefull-scale exercise annually and an additional exercise of the facility’s choice.

12. Other keyelements • Emergency and StandbyPower • Higher level of requirements for hospitals, critical access hospitals, and long-term carefacilities. • Locate generators in accordance with National Fire Protection Association (NFPA) guidelines. • Conduct generator testing, inspection, and maintenance as required byNFPA. • Maintain sufficient fuel to sustain power during anemergency. • Evacuation • Home health agencies and hospices must inform officials of patients in need of evacuation. • EmergencyPlans • Long-term care and psychiatric residential treatment facilities must share information on emergency plan with patient family members orrepresentatives.

13. Implementationtimeline • 2016 • September 15 – Rulepublished • November 15 – Rule goes intoeffect • 2017 • Late winter/ spring – InterpretiveGuidance • released • November 15 – Rule must beimplemented

14. Interpretiveguidelines • Survey and Certification Group (SCG) is currently developing InterpretiveGuidelines (IGs) • State surveyors will use the IGs and survey procedures in the State Operations Manual to assist in implementing the rule • Anticipated release of IGs is Spring2017 • IGs will be formatted into one appendix inthe State OperationsManual

15. Auditing andenforcement • How will rule beaudited? • Compliancemonitoring State Survey Agencies(SSAs) Use IGs and State OperationsManual Accreditation Organizations(AOs) • CMS Regional Offices(ROs) • Checklists for surveyors and State Agencies, as well asfor impacted providers and suppliers are indevelopment. • SCG developing web-based training for surveyors andproviders and suppliers. • Consequence for notcomplying? • Same process for other CoPs and CfCs termination of agreement with Medicare &Medicaid.

16. Costs of implementation • CMS predictions: • $373 million in firstyear • $25 million/yearafter • 72,315 providers & suppliersimpacted • How did CMS arrive at thesenumbers? • Took salaries of impacted employees x hours involved in compliance x number offacilities • Example:Hospice

17. Costs of implementation If government is not providing funding for compliance, how are facilities expected to meet rule requirements?

18. Role of healthcarecoalitions One place to start – HealthcareCoalitions! Rule offers HCCs great opportunity to support members and engage newproviders. Source of preparednessexpertise Regional risk assessments and hazard vulnerabilities Provide template or example plans and policies Help close planninggaps Plan integration with healthcare facilities and local authorities Training andexercises

19. Resources

20. Resources • CMSWebsite • Outline of requirements by providertype • Links to aggregated EPresources • Routinely updated Frequently Asked Questionsdocument • https://www.cms.gov/Medicare/Provider-Enrollment-and- Certification/SurveyCertEmergPrep/Emergency-Prep-Rule.html • HHS/ASPR Technical Resources, Assistance Center, and Information Exchange (TRACIE) • Web-based resource for healthcarestakeholders • TopicCollections • − General Emergency Management & Provider-andSupplier- Specific • Routinely updated CMS Resources at YourFingertips • Submit technical assistance requests https://asprtracie.hhs.gov/cmsrule

21. Resourcescont. • CMSWebinar • Webinar hosted by CMS on the rule inOctober • Slides, transcript, and audio recording postedonline • Federal & Accrediting OrganizationsResources • JointCommission • Emergency ManagementPortal • FEMA Emergency ManagementInstitute • Independent Study onlinecourses • Healthcare Ready CMS KnowledgeCenter • All resources above in oneplace • Running list of relevantarticles • Perspectives from healthcarecoalitions

22. Specific considerations -inpatient

23. Thankyou! Questions?