Dustin M. Ellinger BSN, MHA, RN

Rolf Consulting LLC

Emergency Preparedness: New CMS Rules for ICFs/IID

OHCA / OCID

August 24, 2017

So What’s New?

2012 Life Safety Code • Published: May 4, 2016 (S&C 16-22-LSC)

• Effective: July 5, 2016

• Implementation: November 1, 2016

Emergency Preparedness Rule• Published: September 16, 2016

• Effective: November 15, 2016

• Implementation: November 15, 2017

2012 LSC – References

2012 LSC – Key References

NFPA 101 (2012 ed.)• Life Safety Code Handbook

• Core Chapters (18/19 Health Care)

• Other chapters address means of egress, fire protection, etc.

NFPA 99 (2012 ed.) • Health Care Facilities Code Handbook (for Health Care Occupancies)

• Key Areas Addressed – Gas and Vacuum Systems, Electrical System, HVAC, Medical Gases, Fire Protection

• New Requirement for Risk Assessment

**Other References NFPA 10, NFPA 13, NFPA 25, NFPA 70,

NFPA 72, NFPA 80, NFPA 96, NFPA 110, NFPA 220

“The Form” – CMS-2786V

“The Form” – CMS-2786R

Procedural Changes

Fire Safety Evaluation System (FSES)

• Equivalency concept used in lieu of waivers

• “Grandfathered” buildings no-longer performed by ODH

• Approximately 40-50 buildings affected

• FSES required with annual LSC survey (qualified consultant)

The “Short Form”

• Used for Health Care Occupancy

• Not used as of September 1, 2016

• New process under consideration

Emergency Preparedness

Existing Health Requirements

• W438 – W439(CFR 483.70[h]) Standard: Emergency Plan

and Procedures

(1) The facility must develop and implement detailed written

plans and procedures to meet all potential emergencies and

disasters such as fire, severe weather, and missing clients.

(2) Must communicate, periodically review, make the plan

available, and provide training to the staff

Emergency Preparedness

Existing Health Requirements

• W440 – W451(CFR 483.70[i]) Standard: Evacuation Drills

(1) The facility must hold evacuation drills

• at least quarterly for each shift of personnel

• and under varied conditions

• to ensure all personnel on all shifts are trained to perform assigned tasks

• and ensure that all personnel on all shifts are familiar with the use of the

facility’s fire protection features

• and evaluate the effectiveness of emergency and disaster plans and

procedures

Emergency Preparedness

Existing Health Requirements (CFR 483.70[i], continued)

(2) The facility must

• actually evacuate clients during at least one drill each year on each shift

• make special provisions for the evacuation of clients with physical

disabilities

• file a report and evaluation of each evacuation drill

• investigate all problems with evacuation drills, including accidents

• and take corrective action

• during fire drills, clients may be evacuated to a safe area in facilities

certifed under health care occupancy chapter (18/19) of the Life Safety

Code.

(3) Live-in relief staff must meet quarterly drill requirement

Emergency Preparedness

Existing Health Requirements

• W451 - 439(CFR 483.70[j]) Standard: Fire Protection

(1) The facility must meet Life Safety Code (NFPA 101) health

care occupancy (18/19) or Residential Board and Care

(32/33)

(2) The survey agency may apply one or both occupancy

chapters

(3) Board and Care occupancies must have evacuation

capability evaluated

(4) applicability of state fire code

(5) Must comply with battery lighting (90 min) *

New Preparedness Rules

Emergency Preparedness Rule

Published in Federal Register on September 8, 2016

Effective November 15, 2016

Compliance Expected by November 15, 2017

Advanced Guidelines Published by CMS on June 2, 2017

CFR 483.475 – Condition of Participation: Emergency

Preparedness

• (a)Emergency Plan – based on risk assessment, all-hazards approach

• (b)Policies and Procedures – based on plan and risk assessment

• (c)Communication Plan – coordination of patient care internally and

externally, and communications with emergency officials

• (d)Training and Testing – initial and annual training, drills and exercises

and/or participate in actual incident that tests plan

Advanced Guidance (App. Z)

S&C 17-29-ALL

Published June 2, 2017

Interpretive Guidelines will be incorporated into the State

Operations Manual under Appendix Z

All 17 provider types listed in App. Z

Citations will be cited as “E” Tags (e.g., E0001 to E0044)

State agencies will decide whether evaluated by Health

or Life Safety Code surveyors

Questions about Emergency Preparedness Rule can be

sent to SCGEmergencyPrep@cms.hhs.gov

(a) Emergency Plan

Reviewed and Updated Annually

Community-based, all-hazards approach, including missing

residents

Based on risk assessment (slides to follow)

Population-specific

*Includes:

• continuity of operations

• delegations of authority

• succession plans

• cooperation with state & local leaders

*Templates available online

(b) Policies and Procedures

Subsistence needs for staff and clients, whether evacuating or

shelter

• food, water, medical, and pharmaceutical needs

Alternate sources of energy to

• maintain safe temperature, emergency lighting, fire suppression,

sewage/waste

System to track location of staff and residents

Evacuation (not just locations but “how to”) & transfer

agreements

Means to shelter in place for those remaining

Medical records documentation

Use of volunteers

1135 Waiver

(c) Communication Plan

Names and contact information for:

• Staff

• Entities providing services under arrangement

• Clients’ physicians

• Other ICFs/IID

• Volunteers Federal, state, regional emergency preparedness staff

• Licensing and certification agencies

• State protection and advocacy agencies

Primary and alternate means to contact staff / EMA entities

Method for sharing info with other care providers for continuity

Means to release information

Means of providing general condition and location info

Means of communicating with incident command center

Sharing info with residents / families

(d) Training & Testing

Initial and Annual Training (with documentation)

Unannounced staff drills

Full-scale community-based exercise (unless actual event activates

plan)

Second full-scale exercise or tabletop exercise, with after action

review

Integrated healthcare systems

• May participate in integrated program

• However, each certified facility must participate in development

• Must take into account each facility’s unique circumstances, population,

services

Training and Testing Memo

CMS S&C 17-21 ALL, published March 24, 2017

Training and Testing requirements expected to be fully

met by November 15, 2017

Includes both full-scale, community-based exercise and

tabletop exercise.

Note: CMS says they “understand that a full-scale

community-based exercise may not always be possible

for some providers and suppliers” and outlines provisions

for completing an individual facility-based eoercise with

documentation of why the community-based exercise

couldn’t be completed.

Follow “CMS S&C Policy and Memos to States”

Emergency Rule – FAQ

Continuity of Operations, Delegation of Authority, Succession

Planning

• No specific format or order required but plan must include these elements

• Resource provided below

• http://www.phe.gov/Preparedness/planning/hpp/reports/Documents/hc-

coop2-recovery.pdf (See FAQ #1)

Must be coordinated with local EMA officials – no “sign off”

Community involvement

• Check ODH website for list of existing coalitions

What does training encompass?

• Initial and Annual

• Exercises and Drills

• All Staff, but responsibilities may be delineated

Emergency Rule – FAQ

Hazard Vulnerability Assessment (HVA)

• All Hazard Approach

• No specific form recommended

• Good example: Kaiser Permanente HVA

• http://www.calhospitalprepare.org/hazard-vulnerability-analysis

Typical HVA Components

• Natural Hazards

• Technological Hazards

• Human Hazards

• Hazardous Materials

Emergency Rule – FAQ

Generator for Hospitals, CAH, LTC – may be necessary to

power HVAC system (not explicit in other provider types)

Mandatory Generator vs. Mandatory Alternate Source

of Energy to Maintain Temperatures

• Alt energy source required to maintain temperatures to

protect individuals and storage of provisions

• Must be able to maintain temperatures in emergency

• Could involve heating and cooling in loss of power

• Need to evaluate during risk assessment

• ***NEW GUIDANCE PROVIDED IN APPENDIX Z***

Generator Clarification

This specific standard does not require facilities to have or install generators or any other specific type of energy source

Facilities must establish policies and procedures that determine how required heating and cooling of their facility will be maintained during an emergency situation, as necessary, if there were a loss of the primary power source

If portable generators used, should be operated, tested, and maintained in accordance with manufacturer, local and/or State requirements.

If permanent generator used, must meet NFPA

standards.

Emergency Rule – FAQ

Safe storage of “provisions” means food, water,

pharmaceuticals or medications and medical supplies

No specific quantities of medical supplies (e.g. xx days)

are specified.

Examples of facility or community-based exercises:

• Earthquake, Hurricane, Tornado, Flood

• Blizzard*

• Fire

• Cyber Attack

• Infectious Disease Outbreak

• Medical Surge

• Active Shooter

New Surveyor Tool (E-tags)

Other Resources

OHCA Website / Training Opportunities

“CMS Emergency Preparedness Rule” / Google for website

• Frequently Asked Questions

• Table of Requirements

• Hazard-specific guidance

• Templates and Checklists

Hazard Vulnerability Analysis Tools

• Provider / trade associations (e.g., AHCA)

• Many websites (e.g., Kaiser Permanente, OSHA, FEMA, etc.)

Incident Command System

• FEMA.gov “ICS Resource Center”

Technical Resources, Assistance Center and Information Exchange

• ASPR TRACIE www.asprtracie.hhs.gov

Questions?