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Learning from the CMS Emergency Preparedness Rule and Looking Forward Melissa Harvey, RN, MSPH, Director HHS ASPR NHPP Caecilia Blondiaux, CMS Quality, Safety & Oversight Group Patrick Ashley, MS, MBA, State Hospital Coordinator, Office of Emergency Preparedness, Virginia Department of Health Shayne Brannman, MS, ASPR TRACIE Program Director National Healthcare Coalition Preparedness Conference November 29, 2018

Learning from the CMS Emergency Preparedness Rule and ... · Learning from the CMS Emergency Preparedness Rule and Looking Forward ... Patrick Ashley, MS, MBA, State Hospital Coordinator,

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Page 1: Learning from the CMS Emergency Preparedness Rule and ... · Learning from the CMS Emergency Preparedness Rule and Looking Forward ... Patrick Ashley, MS, MBA, State Hospital Coordinator,

Learning from the CMS Emergency Preparedness Rule and Looking Forward

MelissaHarvey,RN,MSPH,DirectorHHSASPRNHPPCaeciliaBlondiaux,CMSQuality,Safety&OversightGroup

PatrickAshley,MS,MBA,StateHospitalCoordinator,OfficeofEmergencyPreparedness,VirginiaDepartmentofHealth

ShayneBrannman,MS,ASPRTRACIEProgramDirector

NationalHealthcareCoalitionPreparednessConferenceNovember29,2018

Page 2: Learning from the CMS Emergency Preparedness Rule and ... · Learning from the CMS Emergency Preparedness Rule and Looking Forward ... Patrick Ashley, MS, MBA, State Hospital Coordinator,

Disclaimer

Thispresentationwaspreparedasatooltoassistandisnotintendedtograntrightsorimposeobligations.Althougheveryreasonableefforthasbeenmadetoassuretheaccuracyoftheinformationwithinthesepages,theultimateresponsibilityforthecorrectsubmissionofclaimsandresponsetoanyremittanceadvicelieswiththeproviderofservices.ThispublicationisageneralsummarythatexplainscertainaspectsoftheMedicareProgram,HHSOfficeoftheAssistantSecretaryforPreparednessandResponse(ASPR),andVirginiaDepartmentofHealth(VDH),butisnotalegaldocument.TheofficialMedicareProgramprovisionsarecontainedintherelevantlaws,regulations,andrulings.Medicarepolicychangesfrequently,andlinkstothesourcedocumentshavebeenprovidedwithinthedocumentforyourreferenceTheCentersforMedicare&MedicaidServices(CMS),VDH,andHHSASPRemployees,agents,andstaffmakenorepresentation,warranty,orguaranteethatthiscompilationofinformationiserror-freeandwillbearnoresponsibilityorliabilityfortheresultsorconsequencesoftheuseofthisguide.

Page 3: Learning from the CMS Emergency Preparedness Rule and ... · Learning from the CMS Emergency Preparedness Rule and Looking Forward ... Patrick Ashley, MS, MBA, State Hospital Coordinator,

3 Saving Lives. Protecting Americans.

Welcome and Introductions

Melissa Harvey, RN, MSPH Director, Division of National Healthcare Preparedness

Programs (NHPP), HHS ASPR

Page 4: Learning from the CMS Emergency Preparedness Rule and ... · Learning from the CMS Emergency Preparedness Rule and Looking Forward ... Patrick Ashley, MS, MBA, State Hospital Coordinator,

CMSEmergencyPreparednessRuleMedicareandMedicaidPrograms;EmergencyPreparednessRequirementsforMedicareandMedicaidParticipatingProvidersandSuppliers

UnderstandingtheEmergencyPreparednessFinalRuleWhereAreWeNow?

CaeciliaBlondiauxQuality,Safety&OversightGroupCenterforClinicalStandardsandQualityCentersforMedicare&MedicaidServices

Page 5: Learning from the CMS Emergency Preparedness Rule and ... · Learning from the CMS Emergency Preparedness Rule and Looking Forward ... Patrick Ashley, MS, MBA, State Hospital Coordinator,

FinalRule

•  PublishedSeptember16,2016withanimplementationdateofNovember15,2017

•  Appliestoall17providerandsuppliertypes•  CompliancerequiredforparticipationinMedicare(andMedicaid,asapplicable)•  EmergencyPreparednessisonenewCoP/CfCofmanyalreadyrequired

– Forexample,manyprovidersandsuppliersarerequiredtomeetlifesafetycodesthatprotectresidentsagainstfiresandhealthsafetycodesthatkeepareasonabletemperatureforresidents.

•  FacilitiesbeganbeingsurveyedforthenewrequirementsafterNovember2017inconjunctionwiththeirexistingsurveycycles

•  Intheeventfacilitiesarenon-compliant,thesamegeneralenforcementprocedureswilloccurasiscurrentlyinplaceforanyotherconditionsorrequirementscitedfornon-compliance.

5

Page 6: Learning from the CMS Emergency Preparedness Rule and ... · Learning from the CMS Emergency Preparedness Rule and Looking Forward ... Patrick Ashley, MS, MBA, State Hospital Coordinator,

Four Provisions for All Provider Types

Risk Assessment and Planning Policies and Procedures

Communication Plan Training and Testing

Emergency Preparedness

Program

8

Page 7: Learning from the CMS Emergency Preparedness Rule and ... · Learning from the CMS Emergency Preparedness Rule and Looking Forward ... Patrick Ashley, MS, MBA, State Hospital Coordinator,

Emergency Preparedness: An All-Hazards Approach

•  Anall-hazardsapproachisanintegratedapproachtoemergencypreparednessplanningthatfocusesoncapacitiesandcapabilitiesthatarecriticaltopreparednessforafullspectrumofemergenciesordisasters

•  Includesinternalemergencies;man-madeemergencies;naturaldisaster;and/oremerginginfectiousdiseases.

•  Specifictogeographiclocationoftheproviderorsupplierincludingstateandlocalrequirements

•  Thesemayinclude,butarenotlimitedto,care-relatedemergencies,equipmentandpowerfailures,interruptionsincommunications,includingcyber-attacks,lossofaportionorallofafacility,andinterruptionsinthenormalsupplyofessentialssuchaswaterandfood.

7

Page 8: Learning from the CMS Emergency Preparedness Rule and ... · Learning from the CMS Emergency Preparedness Rule and Looking Forward ... Patrick Ashley, MS, MBA, State Hospital Coordinator,

AvailableTrainingResources

•  InSeptember,2017,CMSlaunchedthesurveyortrainingforemergencypreparednessrequirements.Availableathttps://surveyortraining.cms.hhs.gov/

•  TrainingthroughtheIntegratedSurveyorTrainingWebsiteisalsoavailableforproviders/suppliers.

•  Thewebsitealsoprovidesimportantlinkstoadditionalresourcesandorganizationswhocanassist.https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertEmergPrep/index.html

Page 9: Learning from the CMS Emergency Preparedness Rule and ... · Learning from the CMS Emergency Preparedness Rule and Looking Forward ... Patrick Ashley, MS, MBA, State Hospital Coordinator,

Wherearewenow?

•  SurveysbeganinlateNovemberandarebeingconductedbyeitherhealthsurveyorsorLifeSafetyCode(LSC)surveyors

•  Surveysareinconjunctionwithregularlyscheduledsurveycycles

•  Limitedinquiriesinrecentmonthsfromprovidersandsuppliersonwhattodoinordertobecompliant

•  CMSandASPRcontinuetomonitorcomplianceandworkwithhealthcareentities.

Page 10: Learning from the CMS Emergency Preparedness Rule and ... · Learning from the CMS Emergency Preparedness Rule and Looking Forward ... Patrick Ashley, MS, MBA, State Hospital Coordinator,

AnalysisofEPRuleCitations

•  CMSandASPRTRACIEreviewedrecentemergencypreparednessdeficienciesamongprovidertypesfromCMSsurveys

•  Updatingandmonitoringperformanceofhealthcareprovidersandsuppliers:‒  AnalyzingcitationsbasedonsurveysconductedbyCMSbetweenNovember15,2017though

September30,2018‒  Developusefuldisplaytemplates‒  Updatedataevery6months

•  Thepurposeofthiseffortisto:‒  Identifywaystostrengthenemergencypreparednesseffortsofhealthcareprovidersandsuppliersatalllevels(National;State;Regional;andLocalHealthcareEntity)

‒  Enhanceandhonefuturetechnicalassistanceefforts‒  Highlightgeographicvariances‒  Reducesurveyorvariances‒  Createareportingtemplate‒  Createabaselineofinformationthatcanbeupdatedandmonitored

Page 11: Learning from the CMS Emergency Preparedness Rule and ... · Learning from the CMS Emergency Preparedness Rule and Looking Forward ... Patrick Ashley, MS, MBA, State Hospital Coordinator,

OverviewofCurrentCMSEPRuleSurveys

•  CollatedpreliminarycitationsbasedonCMSstatesurveysconductedbetweenNovember15,2017thoughSeptember30,2018

•  Duringthatsametimeperiod:– 74,747healthcareentitieswereeligibleforEPSurveys(includingentitiesthatwereterminatedduringthistime)

– 28,171healthcareentitiesweresurveyedoneormoretimes– Onefacilitycanbesubjecttoupto39Tags(44Tagstotalbutnotallapplytoeachprovider)

– 6,251healthcareentitieswerecitedforatleastonetag• 19,620EPcitationstotalwereissuedtothese6,251healthcareentities

Note:SurveysconductedbyStateSurveyAgenciesinAugustandSeptember2018maynotbereflectedintheanalysisastheyaregiven70daystoreportsurveyoutcomesperreportingrequirements.

Page 12: Learning from the CMS Emergency Preparedness Rule and ... · Learning from the CMS Emergency Preparedness Rule and Looking Forward ... Patrick Ashley, MS, MBA, State Hospital Coordinator,

WhatdotheDataShow?

•  AsofSeptember30,2018,wehavesurveyedover90%ofthenursinghomesand29%ofhospitalsforcompliancewiththeserequirements.Nursinghomesreceiveanannualrecertificationsurvey,whilehospitalsaresurveyedeverythreetofiveyears.

•  Themajorityofproviderssurveyed(78%)metthenewemergencypreparednessrequirements.

•  78%ofnursinghomesand96%ofhospitalsofthosesurveyedbySeptember30,2018fullyincompliancewithrequirements.– 22%ofnursinghomesand4%ofthehospitalssurveyedreceivedatleastonedeficiencycitationunderEmergencyPreparedness.

•  Alldeficienciescitedrequireswiftcorrectionactiontoavoidtermination.Todate,allfacilitiescitedcorrecteddeficienciesandnofacilitieshavebeenterminatedfornotmeetingemergencypreparednessrequirements.

Page 13: Learning from the CMS Emergency Preparedness Rule and ... · Learning from the CMS Emergency Preparedness Rule and Looking Forward ... Patrick Ashley, MS, MBA, State Hospital Coordinator,

CMSAction/NextSteps

•  Withthedataasthecoredriver,CMSwillreviewthetrendsandcontinuetoanalyzecitationsonemergencypreparedness.

•  CMSplanstoworkcloselywithASPRonpotentialareasofimprovement,suchastemplates,additionalresources,andmoreinformationtoassistprovidersincompliance.

•  CMSwillalsoanalyzethespecificcitationstodeterminetheneedforincreasedsurveyortrainingopportunitiesandclarifications.

Page 14: Learning from the CMS Emergency Preparedness Rule and ... · Learning from the CMS Emergency Preparedness Rule and Looking Forward ... Patrick Ashley, MS, MBA, State Hospital Coordinator,

SurveyDataVariability

•  ThedatarepresentedinthisanalysishassomevariabilitybecauseofsurveycyclesanddoesnotincluderesultsofsurveysconductedbyAccreditingOrganizations.TheemergencypreparednessrequirementsaresurveyedbasedonthefacilitytypesregularscheduledsurveycycleinconjunctionwiththeirhealthorLifeSafetyCodeSurveys.

•  Forexample:‒ NursingHomes&ICF/IIDs:Annual-NottoExceed15months‒ HomeHealthAgencies:Generallyevery2to3years‒ Hospitals:Generallyevery3to5years‒ ESRD:Generallyevery3years‒ Hospices:Generallyevery3years‒ RHCs&ASCs:Generallyevery6years‒ CMHCs:Generallyevery5years

Formoreinformationonsurveycycles,pleasevisit:https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/QSOG-Mission-and-Priority-Information.html

Page 15: Learning from the CMS Emergency Preparedness Rule and ... · Learning from the CMS Emergency Preparedness Rule and Looking Forward ... Patrick Ashley, MS, MBA, State Hospital Coordinator,

58

144

184

359

2,084

4,458

4,945

5,867

6,050

6,569

7,345

8,715

12,257

15,712

OrganProcurementOrganization

CommunityMentalHealthCenter

ComprehensiveOutpatientRehabFacility

PsychiatricResidentialTreatmentFacility

OutpatientPhysicalTherapy/SpeechPathology

RuralHealthClinic

Hospice

AmbulatorySurgicalCenter

IntermediateCareFacility/IndividualswithIntellectualDisabilities

Hospital

EndStageRenalDiseaseFacility

FederallyQualifiedHealthCenter

HomeHealthAgency

NursingFacility

NumberofHealthcareEntitiesImpactedbytheCMSEPRuleByProviderType(Nov15,2017–Sept30,2018)

TotalN=74,747 Note:NursingFacilityincludesNursingFacility,SkilledNursingFacility,andSkilledNursingFacility/NursingFacility(DistinctPartandDuallyCertified)

Page 16: Learning from the CMS Emergency Preparedness Rule and ... · Learning from the CMS Emergency Preparedness Rule and Looking Forward ... Patrick Ashley, MS, MBA, State Hospital Coordinator,

[VALUE](10%)

[VALUE](16%)

[VALUE](53%)

[VALUE](17%)

[VALUE](10%)

[VALUE](11%)

[VALUE](15%)

[VALUE](22%)

[VALUE](29%)

[VALUE](31%)

[VALUE](20%)

[VALUE](77%)

[VALUE](90%)

CommunityMentalHealthCenter

ComprehensiveOutpatientRehabFacility

OrganProcurementOrganization

PsychiatricResidentialTreatmentFacility

OutpatientPhysicalTherapy/SpeechPathology

RuralHealthClinic

AmbulatorySurgicalCenter

Hospice

Hospital

EndStageRenalDiseaseFacility

HomeHealthAgency

IntermediateCareFacility/IndividualswithIntellectualDisabilities

NursingFacility

NumberofHealthcareEntitiesSurveyedontheCMSEPRuleByProviderType(Nov15,2017–Sept30,2018)

TotalN=28,171 Note:FederallyQualifiedHealthCenterswerenotsurveyedduringthistimeperiod.

Page 17: Learning from the CMS Emergency Preparedness Rule and ... · Learning from the CMS Emergency Preparedness Rule and Looking Forward ... Patrick Ashley, MS, MBA, State Hospital Coordinator,

NumberofHealthcareEntitiesSurveyedthatReceivedCitationbyProviderType(Nov15,2017–Sept30,2018)

[VALUE](6%)

[VALUE](21%)

[VALUE](21%)

[VALUE](59%)

[VALUE](4%)

[VALUE](37%)

[VALUE](9%)

[VALUE](27%)

[VALUE](27%)

[VALUE](14%)

[VALUE](17%)

[VALUE](37%)

[VALUE](22%)

OrganProcurementOrganization

CommunityMentalHealthCenter

PsychiatricResidentialTreatmentFacility

ComprehensiveOutpatientRehabFacility

Hospital

OutpatientPhysicalTherapy/SpeechPathology

Hospice

RuralHealthClinic

AmbulatorySurgicalCenter

HomeHealthAgency

EndStageRenalDiseaseFacility

IntermediateCareFacility/IndividualswithIntellectualDisabilities

NursingFacility

TotalN=6,251(22%)

Page 18: Learning from the CMS Emergency Preparedness Rule and ... · Learning from the CMS Emergency Preparedness Rule and Looking Forward ... Patrick Ashley, MS, MBA, State Hospital Coordinator,

Top5NationalEPCitations(Nov15,2017–Sept30,2018)

1769

1250 11421004 996

EPTestingRequirements EPTrainingandTesting DevelopandMaintainEPProgram

DevelopmentofEPPoliciesandProcedures

Subsistenceneedsforstaffandpatients

EPTestingRequirements

•  “Failedtoconductexercisestotesttheemergencyplanatleastannually,includingunannouncedstaffdrillsusingtheemergencyprocedure”

•  “Failedtoprovidedocumentationofparticipationinacommunity-basedandtabletopdrill”

EPTrainingandTesting

•  “FailedtoensureEPtrainingandtestingforallstaffwasdocumented,reviewedandupdatedonanannualbasis”

DevelopandMaintainEPProgram

•  “FailedtodevelopandmaintainanEPplanthatwasreviewedandupdatedatleastannually”•  “FailedtoprovidetheannualreviewandupdateoftheirEPProgram”

DevelopmentofEPPoliciesandProcedures

•  “Failuretodevelopandimplementpoliciesandproceduresthatalignswiththehazardsidentifiedwithinthefacility'sriskassessment”

•  “ProvidedincompleteEPpoliciesandprocedures.Thiswasevidencedbyincompletepoliciesandproceduresfordisasteremergenciesrelatingtosewageandwastedisposalandtheuseofvolunteersduringadisasterscenario”

Subsistenceneedsforstaffandpatients

•  TheEPPdidnotincludeprovisionsforemergencyfoodpreparation,foodserviceandwatersupply.”•  “Failedtoprovidedocumentationthattheemergencypreparednessplanaddressvendorcontract

agreementstoprovideprovisionofsubsistenceincludingfoodandwater.”

TopfivenationalEPcitationsrepresent31%(n=6,161)ofthetotalnumberofcitations(n=19,620).

Page 19: Learning from the CMS Emergency Preparedness Rule and ... · Learning from the CMS Emergency Preparedness Rule and Looking Forward ... Patrick Ashley, MS, MBA, State Hospital Coordinator,

NursingFacility IntermediateCareFacility/Ind.withIntellectualDisabilities

HomeHealthAgency EndStageRenalDiseaseFacility

AmbulatorySurgicalCenter

EPTrainingProgram DevelopandMaintainEPProgram

EPTestingRequirements DialysisEmergencyEquipment

EPTestingRequirements

DevelopandMaintainEPProgram

EPTestingRequirements EPTrainingProgram ESRDEPTrainingProgram EmergencyPrepTrainingandTesting

EstablishmentoftheEmergencyProgram

EmergencyPrepTrainingandTesting

PoliciesandProceduresforVolunteers

EPTestingRequirements RolesunderaWaiverDeclaredbySecretary

EmergencyPrepTrainingandTesting

DevelopmentofEPPoliciesandProcedures

ProcessforEPCollaboration

ProcessforEPCollaboration

DevelopandMaintainEPProgram

EPTestingRequirements

DevelopmentofCommunicationPlan

MaintainandAnnualEPUpdates

EmergencyPrepTrainingandTesting

DevelopmentofCommunicationPlan

RuralHealthClinic Hospice Hospital OutpatientPhysicalTherapy/SpeechPathology

ComprehensiveOutpatientRehabFacility

DevelopmentofEPPoliciesandProcedures

EPTrainingProgram EPTrainingProgram PoliciesandProceduresincludingEvacuation

MaintainandAnnualEPUpdates

PoliciesandProceduresforVolunteers

EPTestingRequirements Subsistenceneedsforstaffandpatients

ProcessforEPCollaboration

ProcessforEPCollaboration

EmergencyPrepTrainingandTesting

MaintainandAnnualEPUpdates

DevelopandMaintainEPProgram

EPTrainingProgram EPTrainingProgram

ProcessforEPCollaboration

NamesandContactInformation

RolesunderaWaiverDeclaredbySecretary

EmergencyOfficialsContactInformation

EPTestingRequirements

EPTrainingProgram ArrangementwithotherFacilities

ProceduresforTrackingofStaffandPatients

PoliciesandProceduresforVolunteers

DevelopmentofCommunicationPlan

Top5CitationsbyProviders(Nov15,2017–Sept30,2018)

Highlightedcitationsindicatecitationsseenin5ormoreoftheproviders’top5citationslist.PsychiatricResidentialTreatmentFacilities,CommunityMentalHealthCenters,andOrganProcurementOrganizationswerenotincludedinthetableduetotheirlownumberofcitations.

Page 20: Learning from the CMS Emergency Preparedness Rule and ... · Learning from the CMS Emergency Preparedness Rule and Looking Forward ... Patrick Ashley, MS, MBA, State Hospital Coordinator,

TrainingandTestingProgram

•  CMShasandwillcontinuetoreachouttolocalandstateemergencyofficialstorelayinformationontheEPFinalRule

•  Challengesatstateandlocallevelsare:

‒ Assistingmultiplefacilitiesinexerciseswithlimitedresources‒ Coordinatingexercisesrelevanttofacilities

•  RiskAssessments&CompliantTrainingExercises

Page 21: Learning from the CMS Emergency Preparedness Rule and ... · Learning from the CMS Emergency Preparedness Rule and Looking Forward ... Patrick Ashley, MS, MBA, State Hospital Coordinator,

TheEPFinalRule&1135Waivers

•  TobecompliantwiththerequirementundertheEmergencyPreparednessFinalRule,facilitiesneedtohaveapolicyandprocedureforaddressingyourfacility’sawarenessofthe1135waiverprocess.

•  Thereisnospecificformordocumenttemplateforthepolicyorproceduretomeet

thisrequirement.Someelementsthatcouldbeconsideredandreflected(butnotlimitedto):‒  Facilityroleinprovidingcareandtreatmentatalternatesite–forexample:equipmentand

supplies,commandandcontrol,staffing‒  Collaborationwithlocalofficials–proactiveplanning,pre-designatedsite?Predestinatedroles,

emergencycredentialingproceduresforproviderstopracticeatalternatesite(ifwaiverdoesnotcoverproviderlicensure)

‒  Theprocedureforapplyingforan1135waiverandcontactinformationforRegionalOfficeandStateSurveyAgency.

Page 22: Learning from the CMS Emergency Preparedness Rule and ... · Learning from the CMS Emergency Preparedness Rule and Looking Forward ... Patrick Ashley, MS, MBA, State Hospital Coordinator,

YourRegionalOffices

• WhatistheroleofCMSRegionalOfficeduringanemergency?•  Respondingpromptlytorequestsfor1135(b)waiver

•  Referringquestionsandwaiver/suspensionofregulationrequeststoCMSCentralOffice,asneeded.

•  RequestingstatusreportsfromtheStateAgencyregardingaffectedhealthcareproviders

•  AssistingaffectedStateAgenciestoprovideessentialmonitoringandenforcementactivitiesiftheStateAgencyisoverwhelmed/unabletomeettheirsurveyandcertificationobligations.

Page 23: Learning from the CMS Emergency Preparedness Rule and ... · Learning from the CMS Emergency Preparedness Rule and Looking Forward ... Patrick Ashley, MS, MBA, State Hospital Coordinator,

KeyPoints

•  StateandLocalLaws(muststillcomply)•  EPFinalRuledoesnottakeawayanyexistingrequirements

•  LessonsLearnedfromEvacuations&Adherencetolocal/statemandates

•  StrongandEffectivePartnershipsareCriticaltoEmergencyPreparednessandResponse•  Continuetoanalyzethedatatoensurethatwearelearningfromthoseareasthathealthcareentitiesmaycontinuetostrugglewith–toprovidetechnicalassistanceandresourcesimprovingthepreparednessofourhealthcaresystem.

Page 24: Learning from the CMS Emergency Preparedness Rule and ... · Learning from the CMS Emergency Preparedness Rule and Looking Forward ... Patrick Ashley, MS, MBA, State Hospital Coordinator,

NewAppendixZAnticipatedChanges

• AddingEmergingInfectiousDiseases(guidance/recommendationonly)

•  IncludingNewCitationReferencesforHomeHealthAgencies

•  Clarificationsonuseofportablegenerators:

•  Portableandmobilegeneratorsmust:‒  Beconnectedtothefacilityelectricalsystemthroughacompatibleconnectingdeviceandtransferswitch.‒  Belocatedwhereprotectedfromdamageduringthecourseofanemergency.‒  Notbeoperatedinsidethefacility,inanenclosedareasuch(e.g.,garage,basement),orotherlocationthatwouldnotallowforproperventilationoftheexhaust.

‒  Notbelocatedwhereexhaustfromtheenginewouldbebroughtintothefacilitythroughwindowsorotherventilationsystemintakes.

‒  Notbelocatedinproximitytothebuildingwhereageneratorfirecouldspreadtothefacility.‒  Beoperated,testedandmaintainedinaccordancewithmanufacturer,localand/orStaterequirements.‒  Forrequirementsregardingpermanentlyinstalledgenerators,pleaserefertoexistingLifeSafetyCodeandNFPAguidance.

Page 25: Learning from the CMS Emergency Preparedness Rule and ... · Learning from the CMS Emergency Preparedness Rule and Looking Forward ... Patrick Ashley, MS, MBA, State Hospital Coordinator,

BurdenReductionProposedRule

•  CMSrecentlyreleasedtheproposedBurdenReductionRuleforNonLong-TermCare

•  Theproposalaskedforpublicfeedbackregardingchangestomultipleareas,onebeingtherequirementsforEP(commentperiodclosed11/19)‒ ProposedChangetoDocumentationofcollaborationwithStateandLocalpartners‒ Changestofrequencyofupdatingfromannualtobi-annual&asneeded‒ ChangestotrainingandTestingRequirements

•  Proposedisnotfinal.Facilitiesmustcontinuetocomplywiththecurrentrequirements.

Page 26: Learning from the CMS Emergency Preparedness Rule and ... · Learning from the CMS Emergency Preparedness Rule and Looking Forward ... Patrick Ashley, MS, MBA, State Hospital Coordinator,

Resourcesfor1135Waivers

•  EmailAddressesforCMSRegionalOffices:•  [email protected](AtlantaRO):Alabama,Florida,Georgia,Kentucky,Mississippi,NorthCarolina,SouthCarolina,andTennessee;

•  [email protected](DallasRO):Arkansas,Louisiana,NewMexico,Oklahoma,andTexas•  [email protected](NortheastConsortium):Delaware,DistrictofColumbia,Maryland,Pennsylvania,Virginia,WestVirginia,NewYork,NewJersey,PuertoRico,VirginIslands,Connecticut,Maine,Massachusetts,NewHampshire,RhodeIsland,andVermont

•  [email protected](MidwestConsortium):Illinois,Indiana,Michigan,Minnesota,Ohio,Wisconsin,Iowa,Kansas,Missouri,andNebraska

•  [email protected](WesternConsortium):Colorado,Montana,NorthDakota,SouthDakota,Utah,Wyoming,Alaska,Idaho,Oregon,Washington,Arizona,California,Hawaii,Nevada,andthePacificTerritories.

•  Quality,Safety&OversightGroup1135WaiverResourceWebsiteat:https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertEmergPrep/1135-Waivers.html

Page 27: Learning from the CMS Emergency Preparedness Rule and ... · Learning from the CMS Emergency Preparedness Rule and Looking Forward ... Patrick Ashley, MS, MBA, State Hospital Coordinator,

ResourcesAvailable

•  ASPR’s TRACIE Website ‒ Provider Checklists are available ‒ Risk Assessment Examples

•  CMS encourages facilities to use TRACIE to allow for some level of consistency in format & development of programs

•  Our CMS Website https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertEmergPrep/Emergency-Prep-Rule.html

Page 28: Learning from the CMS Emergency Preparedness Rule and ... · Learning from the CMS Emergency Preparedness Rule and Looking Forward ... Patrick Ashley, MS, MBA, State Hospital Coordinator,

Thankyou!

[email protected]

Page 29: Learning from the CMS Emergency Preparedness Rule and ... · Learning from the CMS Emergency Preparedness Rule and Looking Forward ... Patrick Ashley, MS, MBA, State Hospital Coordinator,

Learning from the CMS Emergency Preparedness

Rule and Looking Forward

•  PatrickAshley,MS,MBA

•  [email protected]

•  StateHospitalCoordinator,OfficeofEmergencyPreparedness,VirginiaDepartmentofHealth

Page 30: Learning from the CMS Emergency Preparedness Rule and ... · Learning from the CMS Emergency Preparedness Rule and Looking Forward ... Patrick Ashley, MS, MBA, State Hospital Coordinator,

VirginiaHealthcareEmergencyManagementProgramVirginia’s System •  6HealthcareCoalitions

•  MirrorPublicHealthRegions

•  COALITIONStaff•  RegionalHealthcareCoordinator•  RHCCManager•  VulnerablePopulationsCoordinator

•  CoalitionMembership•  HPPCoreMembership•  AdditionalRequired:LongTermCare•  Dialysisstronglyencouraged

Page 31: Learning from the CMS Emergency Preparedness Rule and ... · Learning from the CMS Emergency Preparedness Rule and Looking Forward ... Patrick Ashley, MS, MBA, State Hospital Coordinator,

VirginiaHealthcareEmergencyManagementProgramVirginia’s System, Continued •  24/7RHCCActivation• CommonSituationalAwarenessProduct

Page 32: Learning from the CMS Emergency Preparedness Rule and ... · Learning from the CMS Emergency Preparedness Rule and Looking Forward ... Patrick Ashley, MS, MBA, State Hospital Coordinator,

Virginia Healthcare Emergency Management Program Virginia’s System, Continued

VDH CMS Survey Agency

•  VDH Office of Licensure and Certifications

HPP/PHEP Awardee •  VDH Office of Emergency

Preparedness

Shared Executive Oversight

Virginia Emergency Support Team

•  VDEM •  VSP / VDOT •  VDH •  National Guard

Page 33: Learning from the CMS Emergency Preparedness Rule and ... · Learning from the CMS Emergency Preparedness Rule and Looking Forward ... Patrick Ashley, MS, MBA, State Hospital Coordinator,

What does the CMS rule mean to me?

Facilities Emergency Managers Public Health Fire Department EMS Random People Off the Street!

Page 34: Learning from the CMS Emergency Preparedness Rule and ... · Learning from the CMS Emergency Preparedness Rule and Looking Forward ... Patrick Ashley, MS, MBA, State Hospital Coordinator,

Initial Questions

How many facilities are we talking about?

What do facilities need to know? What do partners need to know?

What do partners need to do?

What can we do to help?

Page 35: Learning from the CMS Emergency Preparedness Rule and ... · Learning from the CMS Emergency Preparedness Rule and Looking Forward ... Patrick Ashley, MS, MBA, State Hospital Coordinator,

Opportunity

Page 36: Learning from the CMS Emergency Preparedness Rule and ... · Learning from the CMS Emergency Preparedness Rule and Looking Forward ... Patrick Ashley, MS, MBA, State Hospital Coordinator,

Three Groups of Facilities

Hospitals*

In-Patient/Residential Providers Dialysis Providers

Outpatient Providers

Identify YOUR Priorities It’s OK To Say No.

Page 37: Learning from the CMS Emergency Preparedness Rule and ... · Learning from the CMS Emergency Preparedness Rule and Looking Forward ... Patrick Ashley, MS, MBA, State Hospital Coordinator,

Take the Show on the Road

Meet Them Where They’re Already At. Education Sessions

Local Emergency Managers Facility Groups Public Health Virginia Emergency Management Association Virginia Healthcare Association Leading Age Regional Groups Surveyors

Page 38: Learning from the CMS Emergency Preparedness Rule and ... · Learning from the CMS Emergency Preparedness Rule and Looking Forward ... Patrick Ashley, MS, MBA, State Hospital Coordinator,

Facility Education

What does Emergency Management actually mean? What does the regulation ACTUALLY say? How do I do this? Can you hold my hand?

Can you do it for me?

Page 39: Learning from the CMS Emergency Preparedness Rule and ... · Learning from the CMS Emergency Preparedness Rule and Looking Forward ... Patrick Ashley, MS, MBA, State Hospital Coordinator,

Consulting

For those facilities that just can’t or wont.

Page 40: Learning from the CMS Emergency Preparedness Rule and ... · Learning from the CMS Emergency Preparedness Rule and Looking Forward ... Patrick Ashley, MS, MBA, State Hospital Coordinator,

Exercises

The 3 PM Phone Call. Understanding what the rule says. Regional Exercises. Partnering with Existing Exercises.

Page 41: Learning from the CMS Emergency Preparedness Rule and ... · Learning from the CMS Emergency Preparedness Rule and Looking Forward ... Patrick Ashley, MS, MBA, State Hospital Coordinator,

Surveyor Education

Surveyor Training / Priorities. What’s the number to FEMA? Two Way Dialogue.

•  Funnel Facilities to Coalition for TA •  Event Notification

Joint Surveyor / EP Training.

Page 42: Learning from the CMS Emergency Preparedness Rule and ... · Learning from the CMS Emergency Preparedness Rule and Looking Forward ... Patrick Ashley, MS, MBA, State Hospital Coordinator,

Stakeholder Education

Why are these facilities calling me? Can you make it stop?

Why do I want to engage with these facilities? What can the coalition do to help?

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Training

Hazard Vulnerability Analysis. Brings people together. The topic doesn’t really matter as long as it’s interesting and starts a dialogue. Respect their time. Bring food. Interdisciplinary whenever possible.

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Information Sharing

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What did we learn?

•  Full time "Medically Vulnerable Populations Coordinator" responsible for engaging these groups and getting face time in front of facility decision-makers. Can’t be other duties as assigned.

•  Annual regional exercise opportunities (tabletop and full scale). •  CMS providers often reach out to us following a negative survey or in

preparation for a survey when they realize they are behind the ball. •  Quarterly MVP meetings/workshops on relevant emergency preparedness

topics •  MVP representation on coalition executive board. •  Disclaimers.

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What did we learn?

•  These facilities are not hospitals and have different needs •  Many of these facilities are where hospitals were 20 years ago. •  Bringing emergency management and public health to the table as these

discussions occur is also a feather in the cap for everyone. It lends credibility to the HCC and ensures engagement from other critical partners in the community's emergency response system.

•  Make them sign an MOU with activities defined. •  Like to Like Collaboration and Mutual Aid. •  Engagement of Survey Agency is key.

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ASPR’s Technical Resources, Assistance Center, & Information Exchange

Shayne Brannman, MS, ASPR TRACIE Program Director

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49 Saving Lives. Protecting Americans.

ASPR TRACIE: Three Domains • Self-service collection of audience-tailored materials • Subject-specific, SME-reviewed “Topic Collections” • Unpublished and SME peer-reviewed materials highlighting

real-life tools and experiences

• Personalized support and responses to requests for information and technical assistance

• Accessible by toll-free number (1844-5-TRACIE), email ([email protected]), or web form (ASPRtracie.hhs.gov)

• Area for password-protected discussion among vetted users in near real-time

• Ability to support chats and the peer-to-peer exchange of user-developed templates, plans, and other materials

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50 Saving Lives. Protecting Americans.

ASPRtracie.hhs.gov/tracie-resources

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51 Saving Lives. Protecting Americans.

Healthcare Coalition Resource Examples

•  Coalition Administrative Issues TC •  Coalition Models and Functions TC •  Coalition Response Operations TC •  General Overview of Healthcare Coalitions •  HCC Fiscal Models •  HCC Preparedness Plan •  HCC Recovery Plan Template •  HCC Resource and Gap Analysis Aggregator •  HCC Resource and Gap Analysis Tool •  HCC Response Plan •  HCC Pandemic Checklist •  HCC Select Resources Page •  HCC Webinar Series

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52 Saving Lives. Protecting Americans.

Technical Assistance Trends

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53 Saving Lives. Protecting Americans.

ASPR TRACIE CMS EP Rule Resource Examples

•  CMS EP Rule Resource Page •  CMS and Disasters: Resources at Your

Fingertips •  CMS EP Rule General Briefing Slides •  Integrated Healthcare Systems Implications •  Provider and Supplier Types Covered by the EP

rule Facility-Specific Requirement Overviews •  EP Rule Citation Analysis Project

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54 Saving Lives. Protecting Americans.

ASPR TRACIE and the CMS EP Rule Analysis Project

§  ASPR TRACIE created a baseline EP Rule reporting template that will be routinely updated and monitored

§  Continue identifying ways to strengthen emergency preparedness, response, and recovery efforts at all levels

§  Hone future technical assistance efforts, based on identified knowledge gaps §  Continue highlighting geographic variances §  Continue to be a force multiplier and thought leader §  Listen (and act upon) feedback

ü How can we enhance the reporting template? §  Keep pushing the envelope, with our partners, so we can all learn together

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55 Saving Lives. Protecting Americans.

Contact Us

asprtracie.hhs.gov 1-844-5-TRACIE [email protected]

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56 Saving Lives. Protecting Americans.

Audience Discussion and Q&A