CMS Issues Final Rule for Emergency Preparedness

Natural and manmade disasters have ravaged the United States and the world extensively during the past decade, and they have put healthcare providers – especially hospitals’ emergency teams’ – preparedness to the test.

Natural events, including hurricanes, tornadoes, blizzards, and floods, as well as pre-planned terror attacks such as those that occurred on Sept. 11, 2001, have led to enormous numbers of casualties. Hospitals and health systems have been on the front lines to handle them all, but the federal government is looking to ensure that all healthcare facilities with a community are prepared to meet any possible future emergency challenges.

On Sept. 8, 2016, the Centers for Medicare & Medicaid Services (CMS) proposed a final rule on emergency preparedness planning for 17 types of providers and suppliers that accept Medicare and Medicaid funds. CMS wanted to establish new guidance because the agency believed that the existing emergency preparedness requirements for healthcare facilities were “not comprehensive enough to address the complexities of actual emergencies.”

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 the needs of their patients during disasters and emergency situations.  

“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 Dr. Nicole Lurie, the U.S. Department of Health and Human Services (HHS) 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.”

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 a) communication to coordinate with other systems of care within cities or states; b) contingency planning; and c) training of personnel. CMS proposed policies to address these gaps in the proposed rule, which was open to stakeholder comments.

The recently released CMS Final Rule for Emergency Preparedness contains 651 pages. Throughout the pages of the Final Rule, attention must be paid to the use of words “collaborate / collaboration,” “coordinate/coordination,” and “communicate / communication.” Along with these terms, the Final Rule identifies 17 types of healthcare providers / suppliers.

The basis for developing the Final Rule for Emergency Preparedness was creating continuity of care along with a community of care following the occurrence of major disasters, catastrophes, or outages attributed to nature, accident, or any other intended or non-intended source. The Final Rule notes that “the majority of healthcare provider facilities, both urban and rural, have developed internal plans for emergency preparedness.” However, from a community-coordinated approach, those plans were lacking.

America’s rural communities have many small hospitals, Critical Access Hospitals (CAHs), Federally Qualified Healthcare Centers (FQHCs), Rural Health Clinics (RHCs), Long-Term Care and Skilled Nursing Facilities (LTC/SNF), and hospices. Often only one or two types of these providers are available for community healthcare services. Seldom have they collaborated and developed a comprehensive plan for emergency response.

Where multiple providers are located in a rural community, the CMS Final Rule for Emergency Preparedness provides guidance on how the coordination of community care should occur. Healthcare providers’ compliance with the Final Rule is achieved with plans for emergency backup, communications, policies and procedures, and testing.

Hospitals and all other providers have to use an “all-hazards” approach in their emergency preparedness plan design under the Final Rule. This means providers have to adopt an approach that covers a “broad range of related emergencies internal and external (within) their walls of operations.”

Within the areas of risk assessment and planning, hospitals would have to achieve several goals. For example, hospitals would figure out what other nearby hospitals or healthcare facilities could be used as alternative care sites in cases of emergency or evacuation.

While the importance of emergency preparedness cannot be understated, the new rule will certainly have some administrative and regulatory burdens on rural and urban home health agencies and other healthcare providers.

In fact, the burdens could be heavier for home health care agencies, hospice providers, and other long-term care service providers, as these care settings have not typically had emergency preparedness plans in place, according to Emily Lord, executive director at Healthcare Ready, an organization that works to ensure patient access to healthcare through public/private collaboration.

CMS has also outlined that it intends to tie reimbursement to compliance with emergency preparedness provisions, though the immediate requirements are not yet explicit. For now, the issued Final Rule may cause some immediate burdens for home healthcare companies and the other 16 provider types, but the overall goals of emergency preparedness will likely result in stronger care settings and better patient outcomes.