The Health and Human Services (HHS) Office of Inspector General (OIG) released a report in March on a review of state survey agencies’ abilities to assess nursing homes for compliance with emergency preparedness program requirements.

According to the OIG’s findings, one quarter of state agencies report surveyors lack emergency preparedness expertise when hired and the agencies report challenges in building and retaining that expertise. In addition, OIG also found that surveyor guidance for emergency preparedness tends to focus more on collecting documentation to demonstrate compliance with requirements than on assessing the content of the nursing home’s emergency preparedness program.

OIG made two recommendations to the Centers for Medicare & Medicaid Services (CMS) to address these issues, with which CMS concurred:

1. Provide surveyors with instructions for how to assess the contents of nursing home emergency preparedness documentation as a part of the survey process.
2. Issue guidance that encourages state survey agencies to collaborate and share information.

LeadingAge notes that these recommendations could have an immediate impact on future policy actions from CMS.

Drawing on a Biden Administration-initiative to improve emergency preparedness and response in nursing homes, CMS had previously submitted a proposed rule to the Office of Management and Budget (OMB) in October 2023 for review. This rule remained under review at OMB until January 2025 when it was withdrawn by the Trump Administration, likely as a result of Executive Order Regulatory Freeze Pending Review that directed all regulatory actions that had not yet taken effect to be withdrawn and reviewed for consistency with the new Administration’s policies.

As of March 20, the end of the regulatory review period, the rule had not yet been re-submitted to OMB. With this report from OIG, it remains to be seen whether a rule will be forthcoming or whether the Trump Administration will refocus resources on improving sub-regulatory guidance.