The Centers for Medicare and Medicaid Services (CMS) have proposed new emergency preparedness requirements for healthcare providers and suppliers. These new requirements are designed to address the effect of a broad range of natural and man-made disasters—like attacks, epidemics, flooding, hurricanes and tornadoes—on the healthcare environment. The proposed regulations focus on safeguarding human resources, ensuring business continuity and protecting physical resources. CMS believes the current regulations for Medicare and Medicaid program providers and suppliers do not adequately address these key elements.

The proposed regulations affect 17 types of Medicare and Medicaid providers and suppliers. Facilities under the proposed regulations must devise an emergency plan based upon a broad risk assessment and then develop and maintain (1) policies and procedures addressing emergency preparedness,
(2) an emergency communication plan that complies with state and federal laws, and (3) a training program that includes initial and annual trainings and is routinely tested by drills.

CMS expects the implementation of the proposed regulations would not be the same for all providers and suppliers, depending on their category. For example, the implementation of policies and procedures to provide subsistence needs to staff and patients during a disaster would be different for a rural health clinic compared to a large metropolitan hospital. In addition, each facility may need to consider individual factors in determining how to effectuate a requirement, such as the amount of space available within the facility for storing provisions or the provider’s capabilities and capacities for notifying staff and patients not to come to the facility due to an emergency.

Before developing an emergency plan, CMS proposes that facilities conduct an all-hazards risk assessment, an integrated emergency preparedness approach that is specific to the location of the provider and supplier, considering the particular types of hazards likely to occur in or near that location. Facilities developing emergency plans also will need to consider the possibility of emergencies or responses to emergencies that cross state lines. CMS anticipates that facilities work in collaboration with hospitals and other providers and suppliers across state borders in order to ensure continuity of care during an emergency.

Many of the proposed regulations rely on standards already required by third-party accreditation bodies. In particular, CMS has proposed requirements that are similar, and in some cases identical, to the standards required by The Joint Commission (TJC). For example, the proposed regulations require hospitals to have policies and procedures for a plan of safe evacuation. TJC-accredited hospitals, however, must have plans for evacuation as part of their clinical operations management. Nonetheless, facilities that have TJC accreditation still may find it challenging to meet some of the more onerous requirements proposed by CMS. For facilities that do not have TJC accreditation, many of the proposed requirements may be new and require significant changes, and facilities may incur significant costs in doing so.

The proposed regulations will be incorporated into the Medicare and Medicaid programs as Conditions of Participation for providers and as Conditions of Coverage for suppliers. CMS currently is soliciting comments for recommendations and changes or amendments from the public. Final comments are due to CMS by the extended deadline of March 31, 2014.

Although the proposed rule has not yet been finalized, CMS is beginning to reform its emergency preparedness requirements. For example, at the end of February, CMS updated its emergency preparedness checklist for state surveyors.