by Michael Kotch
May 26, 2020
This is a brief overview of the Centers for Medicare and Medicaid Services’ (CMS) rule mandating emergency preparedness for 17 types of Medicare and Medicaid providers and suppliers.
As we continue to experience the impact of COVID-19 on our health care system, it is a good time to reflect on lessons learned regarding emergency preparedness and response. Business continuity plans are required under 42 CFR § 422.504 (o) and §423.505 (p) to ensure restoration of business operations following natural or man-made disruptions. CMS recommends that current business continuity plans include necessary planning for business operations disruption due to a pandemic public health emergency.
The CMS Emergency Preparedness Rule focuses on the development and implementation of an emergency preparedness plan, policies and procedures, a communications plan, training and testing requirements, and specialized provisions dealing with emergency and backup power supplies for certain provider and supplier types.
The regulation implies that providers and suppliers that comply with emergency planning criteria, such as standards set by The Joint Commission, may be considered compliant for some aspects of the emergency preparedness plan. However, there is significant focus directed towards the guidance and tools available through the Assistant Secretary for Preparedness and Response - Technical Resources, Assistance Center, and Information Exchange (ASPR-TRACIE) to meet compliance requirements.
In addition, the Federal Emergency Management Agency (FEMA) Guide on Emergency Preparedness and Emergency Operation Plans and the FEMA Comprehensive Preparedness Guide of 2010 are recommended resources for Medicare and Medicaid providers and suppliers to help meet compliance requirements.
In the annual Department of Health and Human Services (HHS) publication of the Top Management and Performance Challenges for 2019 the HHS Office of Inspector General (OIG) identified emergency preparedness planning as one of the top six (6) areas requiring attention.
While the HHS has a lead role in preventing, preparing for, and responding to the adverse health effects of public health emergencies, it important for Medicare and Medicaid providers and suppliers to be prepared to handle public health emergencies such as communicable diseases, outbreaks, and natural disasters that can severely strain the health care infrastructure.
The CMS Emergency Preparedness Rule emphasizes the importance of having adequate planning and mechanisms in place prior to and during a national emergency to efficiently and rapidly deploy assets and provide relief to those in need. Prior OIG work has identified a number of gaps in emergency preparedness and response planning for health care facilities during disasters and pandemics. A concerted effort to improve preparedness and response is important and necessary to deliver health care services during a natural disaster, as well as support an effective recovery.
A 2019 OIG report found that HHS was deficient in several key areas, including (1) inadequate planning for coordinating global health security, (2) insufficient preparation for deployment of the resources needed for an adequate response, and (3) a lack of internal and external communication channels for responding to a public health emergency. The Medicare and Medicaid provider and supplier types identified in the CMS Emergency Preparedness Rule should note the OIG findings and ensure planning and preparedness includes provisions to address (1) coordination of security, (2) deployment and re-supply of resources such as personal protective equipment, vaccines, anti-viral drugs, anti-biotics and other medications, and medical equipment, (3) internal and external communications channels, and (4) procedures for handling medical surge.
The CMS Emergency Preparedness Rule is intended to safeguard human resources, protect physical resources, and maintain business continuity. It applies to the 17 Medicare and Medicaid provider and supplier types identified in the following table:
While all 17 Medicare and Medicaid provider and supplier types are impacted by the CMS Emergency Preparedness Rule, requirements may differ between each provider and supplier type. In Part 2 we will outline and discuss the general requirements of the CMS Emergency Preparedness Rule.
References and Sources:  https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertEmergPrep/Emergency-Prep-Rule  https://asprtracie.hhs.gov  https://www.fema.gov/pdf/plan/slg101.pdf  https://www.fema.gov/media-library-data/1573581112287-035972e4d26817854c833457863c34cc/201911Listening_CPG_101_V2_22NOV2010.pdf  https://www.oig.hhs.gov/reports-and-publications/top-challenges/2019/2019-tmc.pdf#page=18  https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertEmergPrep/Emergency-Prep-Rule  https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/som107ap_z_emergprep.pdf  https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertEmergPrep/Downloads/SandC_EPChecklist_Persons_LTCFacilities_Ombudsmen.pdf  https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertEmergPrep/Downloads/17-Facility-Provider-Supplier-Types-Impacted.pdf
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