CMS Releases Updated Emergency Preparedness Guidance

From the National Association for Home Care & Hospice (NAHC)

The Centers for Medicare & Medicaid Services (CMS) has released emergency preparedness (EP) guidance for surveyors, as well as providers and suppliers, with assessing a facility’s compliance with the EP requirements. Both home health agencies and hospice providers must conduct exercises to test the emergency plan at least annually, and both inpatient and outpatient providers that activate their emergency plans are exempt from the next required full-scale community-based or individual, facility-based functional exercise. This exemption is based on the facility’s 12-month exercise cycle. The cycle is determined by the facility (e.g. calendar, fiscal or another 12-month timeframe).

The 2019 CMS revisions to the EP testing exercise mandates included, requirements for facilities to conduct exercises to test the facility’s EP plan to ensure that it works and that staff are trained appropriately about their roles and the facility’s processes.

During or after an actual emergency, the regulations allow for a one-year exemption from the requirement that the facility perform testing exercises. There are different types of exercises required for inpatient providers and outpatient providers and which of these exercises was exempt after an actual emergency was causing some confusion for providers.  This was compounded by the Public Health Emergency (PHE), and many providers are still operating under disaster/emergency conditions during the PHE, i.e., under an activated emergency plan.

For providers of inpatient services (includes inpatient hospice facilities):

These providers are still required to conduct two emergency preparedness testing exercises annually

• a full-scale exercise (or individual facility-based exercise when a full-scale is not 

• any one exercise of the “exercises of choice” which include another full-scale or individual facility-based exercise, table top exercise, workshop or mock drill annually.

When an inpatient provider activates its emergency program due to an actual emergency, the provider would be exempt from engaging in its next required community based full-scale exercise or individual facility-based exercise following the onset of the emergency event. Facilities must be able to demonstrate through written documentation, that they activated their program due to the emergency.

If the facility is still operating under its currently activated emergency plan, any currently activated emergency plan will be recognized by surveyors as having met the full-scale exercise requirement for 2021 (even if it claimed the exemption for the 2020 full-scale exercise). If the facility claimed the full-scale exercise exemption in 2020 based on its activated emergency plan and has since resumed normal operating status, the inpatient provider/supplier is expected to complete its required full-scale exercise in 2021, unless it has reactivated its emergency plan for an actual emergency during its 12-month cycle for 2021.

Example: Facility Y conducted a table-top exercise in January 2020 as the exercise of choice and was exempt from its scheduled full-scale exercise in November 2020 due to the COVID-19 PHE (that began in March 2020) and activation of its emergency plan. The facility in March 2021 resumed normal operations and is no longer operating under activation of its emergency plan.  Since the facility is no longer under its activated emergency plan, the facility is required to conduct its full-scale exercise or individual facility-based exercise.

For providers of outpatient services (includes home health agencies and non-inpatient hospice facilities):

These providers must still conduct annual testing – a full-scale exercise (or individual facility-based exercise when a full-scale is not available) every two years and in opposite years conduct any one of the “exercises of choice,” which include another full-scale or individual facility-based functional exercise, table top exercise, workshop, or mock drill.  In other words, outpatient services facilities are required to conduct one annual exercise- alternating full-scale and exercise of choice.  Outpatient providers will continue to follow the guidance issued in 2019, as the facility was either exempt from the full-scale exercise in 2020 or in 2021, depending on its cycle of testing exercises.

Example: Facility Y conducted a table top exercise in January 2019 as the exercise of choice and conducted a full-scale exercise in January 2020. In March 2020, Facility Y activates its emergency preparedness program due to the COVID-19 PHE.  The facility is exempt from the January 2022 full-scale exercise for that “annual year”. However, the facility must conduct its exercise of choice by January 2021, and again in January 2023.