On December 27, CMS issued a proposed rule that would establish national emergency preparedness requirements for Medicare and Medicaid participating providers and suppliers to ensure that they adequately plan for both natural and man-made disasters, and coordinate with federal, state, tribal, regional, and local emergency preparedness systems. It would also ensure that these providers and suppliers are adequately prepared to meet the needs of patients, residents, clients, and participants during disasters and emergency situations.
CMS is proposing emergency preparedness requirements that 17 provider and supplier types must meet to participate in the Medicare and Medicaid programs. Since existing Medicare and Medicaid requirements vary across the types of providers and suppliers, we are also proposing variations in these requirements. These variations are based on existing statutory and regulatory policies and differing needs of each provider or supplier type and the individuals to whom they provide health care services. Despite these variations, our proposed regulations would provide generally consistent emergency preparedness requirements, enhance patient safety during emergencies for persons served by Medicare- and Medicaid-participating facilities, and establish a more coordinated and defined response to natural and man-made disasters.
The proposed rule has a section dedicated to long-term care facilities:
- H. Emergency Preparedness Requirements for Long Term Care (LTC) Facilities (§ 483.73)
The rule states that the current requirements are not sufficient to ensure that facilities are prepared for more widespread disasters that may affect most or all of the other health care facilities in their area and that may tax the ability of local, state, and federal emergency management officials to provide assistance. For example, current LTC facility requirements do not require facilities to conduct a risk assessment or to have a plan, policies, or procedures to ensure continuity of facility operations during emergencies.
The report reads: We believe the additional requirements in this proposed rule would ensure facilities would be prepared for the emergencies they may face now and in the future. Thus, our proposed emergency preparedness requirements for LTC facilities are identical to those we are proposing for hospitals at § 482.15, with two exceptions. Specifically, at § 483.73(a)(1), we propose that LTC facilities would establish emergency plans utilizing an “all-hazards” approach, which in an emergency situation, would include a directive to account for missing residents.
In addition, long-term care facilities are unlike many of the inpatient care providers. Many of the residents can be expected to have long term or extended stays in these facilities. Due to the long term nature of their stays, these facilities essentially become the residents’ residences or homes. We believe this changes the nature of the relationship and duty to the residents and their families or representatives. Section § 483.73(c) requires these facilities to develop an emergency preparedness communication plan, which includes, among other things, a means of providing information about the general condition and location of residents under the facility’s care. We also believe that the residents and their families or representatives require more information about the facility’s emergency plan. Specifically, long term care facilities should be required to determine what information in their emergency plan is appropriate to share with its residents and their families or representatives and that the facility have a means by which that information is disseminated to those individuals. The facility should also determine the appropriate time for that information to be disseminated. We are not indicating what information from the emergency plan should be shared or the timing or manner in which it should be disseminated. We believe that each facility should have the flexibility to determine the information that is most appropriate to be shared with its residents and their families or representatives and the most efficient manner in which to share that information. Therefore, we propose to add an additional requirement at § 483.73(c)(8) that reads, “A method for sharing information from the emergency plan that the facility has determined is appropriate with residents and their families or representatives.”