CMS rule would standardize emergency preparedness for healthcare providers

Coast Guardsmen use a flat-bottom boat to assist residents during severe flooding around Baton Rouge, LA on Aug. 14, 2016. Coast Guard photo by Petty Officer 3rd Class Brandon Giles (Wikipedia)

Last week, the Centers for Medicare and Medicaid Services finalized a rule it said would establish consistent emergency preparedness requirements for healthcare providers participating in Medicare and Medicaid. The rule is also intended to increase patient safety during emergencies, and establish a more coordinated response to natural and man-made disasters.

The health and safety of Medicare and Medicaid beneficiaries -- and the public at large -- had been a concern of the agency's over the past several years, most recently due to the flooding in Baton Rouge, Louisiana. These new requirements will require certain participating providers and suppliers to plan for disasters and coordinate with federal, state tribal, regional and local emergency preparedness systems to ensure that facilities are adequately prepared to meet patients' needs during disasters and emergency situations.

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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. In Particular, CMS said the requirements did not address the need for communication to coordinate with other systems of care within cities or states; nor did they address contingency planning or the training of personnel. CMS floated policies to address these gaps in the proposed rule, which was open to stakeholder comments.

After incorporating those stakeholders' views, CMS decided to implement four best practice standards into its rule. The first is the creation of an emergency plan based on a risk assessment, and using an "all-hazards" approach to ensure that region-specific disasters have contingencies in place.

CMS also proposed developing and implementing policies and procedures based on the plan and risk assessment; maintaining a communication plan that complies with both federal and state law; and creating training and testing programs, including annual trainings, drills and exercises.

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Those standards are flexible depending on the type of provider or supplier. For example, outpatient providers and suppliers such as ambulatory surgical centers and end-stage renal disease facilities will not be required to have policies and procedures for the provision of subsistence needs. Meanwhile, hospitals, critical access hospitals, and long term care facilities will be required to install and maintain emergency and standby power systems based on their emergency plan.

In response to comments, CMS made changes in several areas of the final rule, including removing the requirement for additional hours of generator testing, flexibility to choose the type of exercise a facility conducts for its second annual testing requirement, and allowing a separately certified facility within a healthcare system to take part in the system's unified emergency preparedness program.

The final rule also includes a number of local and national resources related to emergency preparedness, including reports, toolkits and samples. Additionally, healthcare providers and suppliers can choose to participate in their local healthcare coalitions, which provide an opportunity to share resources and expertise in developing an emergency plan and also can provide support during an emergency.

These regulations are effective 60 days after publication in the federal register. Providers and suppliers affected by the rule have to comply with and implement all of the regulations one year after the effective date.

"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," said Dr. Nicole Lurie, the U.S. Department of Health and Human Services' assistant secretary for preparedness and response, in a statement. "Disasters tend to stress the entire healthcare system, and that's not good for anyone."

Twitter: @JELagasse