Centers for Medicare and Medicaid Services (CMS) Emergency Preparedness Rule

CMS Administers and regulates Medicare Medicaid and CHIP (state partnership) HIPAA Provisions of the ACA Supports state agencies (Utah Health Facility Licensing, Certification, and Resident Assessment) Other activities and programs

CMS and Disasters Even with all the work we have done, disasters continue to devastate healthcare facilities and suppliers Hurricane Sandy (2012) 5 hospital evacuations – 1,300 people 17 nursing homes evacuated – 2,507 people 14 adult care facilities – 1,999 people Healthcare system is still struggling to recover Hospitals took weeks to 18 months to reopen Some are still not back to 100% services “we” is the collective One example of many is Hurricane Sandy

CMS Regulation Reviews CMS conducted a review of existing guidance from CDC, ASPR, NFPA, Joint Commission and others Conducted review of existing CMS requirements for providers and suppliers Lack of consistent regulatory approach Requirements did not address Communication with external partners Contingency planning Training of personnel

CMS Regulation Reviews CMS determined Current regulations were a patchwork Often based on guidance or standards Difficult to enforce May not provide adequate protections to the health and safety of patients or clients That a national-level, comprehensive, enforceable, consistent regulatory approach was needed across multiple provider types

CMS EP Draft Rule Draft Rule posted – December 2013 Three years of feedback and revisions Final Rule posted – September 2016, in effect November 2016 Impacts 17 types of entities, and will be fully enforceable November 2017 Revises the Conditions of Participation for providers and Conditions of Coverage for suppliers to participate in Medicare/Medicaid 8 of the 17 impacted entity types have been identified in SW Region This also applies to any services that are contracted out by the impacted entity

Impacted Entities in Utah (542) Type # Hospital 60 Skilled Nursing 118 Hospice 92 Home Health 106 CHC/FQHC 49 Dialysis 44 Ambulatory Surgical Center 43 Rural Health Clinic 16 Outpatient Rehab 9 Psych Residential 5 Almost 550 entities in the state impacted by the Rule CHC/FQHC – Community Health Centers/Federally Qualified Health Centers The full list of types include RNHCIs - Religious Nonmedical Health Care Institutions ASC - Ambulatory Surgical Center PRTF - Psychiatric Residential Treatment Facilities PACE - Program for the All-Inclusive Care for the Elderly LTC - Long Term Care ICFs/IID - Intermediate Care Facilities for Individuals with Intellectual Disabilities HHA - Home Health Agencies CORF - Comprehensive Outpatient Rehabilitation Facilities CAH - Critical Access Hospital CMHC - Community Mental Health Center OPO - Organ Procurement Organization RHC - Rural Health Clinic FQHC - Federally Qualified Health Center ESRD - End-Stage Renal Disease (Dialysis)

“The Rule” Overarching principles Safeguard human resources Ensure business continuity Protect physical resources Use All-Hazards approach Integrate into daily functions Update annually

“The Rule” Rule Categories Emergency Planning Policies and Procedures Communications Plan Training and Testing Items noted with * might be accessible from local partners We can note that local partners may include the Regional Coalition, but others can assist with this as well

Risk Assessment and Planning Risk/Hazards Assessment – HVA* Based on entity and community* risks Entity-level response plan, updated annually Addresses patient needs, continuity, and delegation of authority Includes collaboration with local and regional preparedness officials*

Policies and Procedures Based on risk assessment and response plan Address client care and service Communication with officials about client evacuation/movement needed* Tracking location of staff and patients Medical records protected and available Use of volunteers* Coordination with other agencies for coverage and support

Communication Plan Contact info for staff, contractors, patients providers, other entities Contact info for jurisdictional staffing and other sources of assistance* Alternate/redundant communication plan* Method for sharing medical documentation Comms with Incident Command about patients in need and status of entity*

Training Program Initial training on disaster policies and procedures to new and existing staff Annual emergency preparedness training* Documentation of training Demonstration of knowledge by staff

Testing Program Consists of drills and exercises* Community mock disaster drill annually, if not available, then facility disaster drill* A real event will exempt from exercise requirement Conduct annual tabletop exercise*