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

2. 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

3. 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

4. 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

5. 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

6. 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

7. 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)

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

9. “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

10. 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*

11. 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

12. 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*

13. 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

14. 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*