On May 26^th, the Centers for Medicare and Medicaid Services (CMS) issued an update to QOS-20-41-ALL, which exempted providers who activated their emergency plans after the President declared a national emergency due to COVID-19 from the next required full-scale community-based or individual, facility-based functional emergency preparedness exercise. The updated guidance states that providers who continue to operate under their emergency plans or providers who have reactivated their emergency plans related to the COVID-19 public health emergency can count these operations toward satisfying the requirements for full-scale community-based or individual facility-based functional exercises.

CMS further clarified expectations for outpatient providers, which includes home health agencies, hospices, and Program for the All-Inclusive Care for the Elderly (PACE).

• Outpatient Provider Exemption in 2020: If an agency activated its emergency plan for COVID-19 response in 2020 and has since resumed normal operating status, the outpatient provider is expected to complete its required full-scale exercise in 2022, unless it has reactivated its emergency plan for an actual emergency during its 12-month cycle for 2022.
• Outpatient Provider Exemption in 2021: If an agency activated its emergency plan for COVID-19 response in 2021 and has since resumed normal operating status, the outpatient provider is expected to complete its required full-scale exercise in 2024.

CMS classified inpatient hospice providers as inpatient providers which have slightly different guidelines for exemption.

• Inpatient Hospice Provider Exemption Currently Active: If an inpatient hospice is still operating under its currently activated emergency plan during its specified 12-month cycle of testing exercises, any currently activated emergency plan will be recognized by surveyors as having met the full-scale exercise requirement for that 12-month cycle.
• Inpatient Hospice Provider Exemption in 2020 and 2021: If an inpatient hospice claimed the full-scale exercise exemption in 2020 and 2021 based on its activated emergency plan for COVID-19 response and has since resumed normal operating status, the inpatient hospice is expected to complete its required full-scale exercise, unless it has reactivated its emergency plan for an actual emergency during its 12-month cycle for 2022.

Home health agencies, hospices and PACE providers should continue to document their activation of emergency plans for COVID-19 as well as any other disaster or emergency such as winter storms or wildfires. Exemptions do not accumulate or carry over to following full-scale exemption because the agency faced two separate emergency activations.