Among other requirements, the rule, which applies to 17 categories of providers including SNF/NFs, hospice, home health and PACE, requires providers to take an “all –hazards” approach in developing an emergency preparedness plan. Such an approach focuses on capacities and capabilities that are critical to preparedness for a full spectrum of emergencies or disasters, including internal emergencies, man-made emergencies and natural disasters. This approach is specific to the location of the provider and considers the particular type of hazards most likely to occur in that area. These may include, but are not limited to, care-related emergencies, equipment and power failures, interruptions in communications, including cyber-attacks, loss of a portion or all of a facility, and interruptions in the normal supply of essentials such as water and food.

Although CMS gave a brief summary of the final emergency preparedness rule, the agency focused on the training and testing requirements of the regulation. Specifically, the regulation requires providers to:

• Develop and maintain training and testing programs, including initial training in policies and procedures;

• Demonstrate knowledge of emergency procedures and provide training at least annually; and

• Conduct drills and exercises to test the emergency plan.

CMS expects providers to meet ALL training and testing requirements by the Nov. 15, 2017 implementation deadline. Of particular concern for providers is the requirement to conduct drills and exercises to test their emergency plan. That requirement calls for providers to:

• Participate in a full-scale, community-based exercise (or when a community-based exercise is not accessible, an individual, facility-based exercise); and

• Conduct either a second full-scale individual, facility-based exercise, or a table top exercise.

A full-scale, community-based exercise is a multi-agency, multi-jurisdictional, multi-discipline exercise involving functional (for example, joint field office, emergency operation centers, etc.) and/or ‘‘boots on the ground’’ response (for example, firefighters decontaminating mock victims).

A facility-based exercise is similar to a community-based exercise but is more limited and hazards specific to a facility based on the geographic location; Patient/Resident/Client population; facility type and potential surrounding community assets (i.e. rural area versus a large metropolitan area).

A table-top exercise is a group discussion led by a facilitator, using a narrated, clinically relevant emergency scenario, and a set of problem statements, directed messages, or prepared questions designed to challenge an emergency plan. It involves key personnel discussing simulated scenarios, including computer-simulated exercises, in an informal setting. Table-top exercises can be used to assess plans, policies, and procedures.

CMS encourages providers to seek out local and/or state emergency agencies and health care coalitions to participate in a full-scale, community-based exercise.

There are no exceptions to the requirements for small or rural facilities. Noncompliance is subject to the same enforcement procedures as any other conditions or requirements.

Materials from the call, including a recording (available mid-May) are available on the MLN Connects Website.  Additional information can be found on the CMS Emergency Preparedness Website.