Below is an updated version of an article that appeared in the February 2014 edition of the IAEM Bulletin. It was written by Crisis Focus Principals: Jody Moore, MBA, CEM and Don Campbell, MS, CEM. The original article can be accessed by visiting the IAEM website. Supporting posts around the proposed regulations can be found linked at the end of the article.
In December of 2013, the Centers for Medicare and Medicaid Services (CMS) released proposed rule changes that would create statutorily obligated emergency preparedness efforts for both governmental and private-sector health care providers. The proposed rule change introduces new Conditions of Participation (CoPs), standards providers must continually meet to participate in the Medicare and Medicaid programs and receive the commensurate reimbursement for services.
This reimbursement can be $2,000 per business day for small providers or exceed $2 million per calendar day for large institutions. If or when these proposed changes go into effect, health care providers will be at significant risk of a major loss if found deficient.
EM Requirements Not New in the Health Care Sector
Emergency management requirements are not new in the health care sector. Over the past decade, health care emergency management has developed into a full specialty. Most large hospitals have a full-time emergency manager on staff, with many regional health systems having full-fledged emergency management programs with staff and commensurate operating budgets.
This growth principally has been in response to the lessons learned from 9/11, Hurricane Katrina, Sandy, and other large-scale incidents, driven by emergency management requirements from the agencies that accredit health care providers, such as hospitals and home health agencies (The Joint Commission, DNV, and others).
New Proposal to Cover More Health Care Organizations
The major change to the current regulatory climate is the expanded number of health care organizations that now will be required to meet emergency preparedness standards. The following provider types are covered under the new proposal:
- Critical Access Hospitals
- Long Term Care Facilities
- Intermediate Care Facilities
- Psychiatric Residential Group Facilities
- Transplant Centers
- Hospice Agencies
- Ambulatory Surgical Centers
- Programs for All Inclusive Care for the Elderly (PACE)
- Home Health Agencies
- Comprehensive Outpatient Rehab Facilities (CORF)
- Community Mental Health Centers (CMHC)
- Organ Procurement Organizations (OPO)
- Clinics for Rehabilitation and Therapy
- Rural Health Clinics/Federally Qualified Health Clinics (RHC/FQHC)
- End Stage Renal Disease “Dialysis Centers” (ESRD)
While some of these providers already fall under state-based disaster regulations, this proposal greatly expands the number of facilities required to plan, train, and conduct exercise programs to meet an all-hazards preparedness standard.
Expect a Significant Impact
With regard to the planning requirements proposed, the document does not appear to introduce any new groundbreaking emergency management ideas. However, it will most likely result in a significant impact on local emergency managers and health care facility operators. The proposal identifies the following four areas of focus:
- Develop an all-hazards plan based on a risk analysis.
- Develop and implement supporting policies and procedures.
- Develop a compliant communications plan, including coordination among local, state and federal partners.
- Develop and maintain a training and validation program, including exercises and actual incidents.
These standards will likely lead to an increased burden on local officials, as providers attempt to first understand the basics of emergency management and then attempt to test their plans. Local agencies will be inundated with requests for exercises or training, not only from hospitals, but also from the other 16 types of medical providers that must be compliant with the CoPs to continue to receive Medicaid and Medicare revenue.
Are Local Agencies Equipped to Meet the Expected Demand?
The majority of municipalities traditionally welcome the interactions and improved partnerships with constituents, which the new rules will encourage. This will drive the question: are local agencies equipped with the resources to meet the needs of the requests? If the agency is not resourced appropriately and does not have the means to increase its capacity, its focus should be shifted to creating a well-packaged product representative of the local emergency management program, to include capabilities, policies, applicable procedures, and areas for interoperable communication. The local agency must establish a consistent manner in which to handle and meet these additional requests.
Prepare for the Impact Today
While this document is most likely at least a year away from becoming law, the opportunity to prepare for the impact is today. The comment period closed on March 31, 2014, but can be reviewed at www.regulations.gov. Even though the rule’s implementation period will likely be staggered, time will still be limited to meet compliance. Local agencies will not only need to develop consistent processes to meet constituents’ needs, but also must identify whether collaborative agencies, such as health care coalitions, are already functioning within their jurisdiction. CMS is obviously striving to bring national level consistency for health care provider emergency preparedness, and it is a great opportunity for emergency managers to step into the limelight to better prepare our health care community.
More Posts about the Proposed Law:
Edits were made on this document initially to reflect the change in date on the comment period and then again to reflect the comment period had closed.