Preparedness and Response Blog

Medicare Emergency Preparedness Standards Just Around the Corner

Written by Bill Finerfrock | Nov 28, 2016 8:27:34 PM

Natural and man-made disasters are sweeping news feeds and TV channels almost weekly.  With floods in Louisiana and Texas, hurricanes along the East Coast, wild fires out West, and snow storms in the Midwest, it is evident that no region of the country is immune to these unfortunate events.

In light of such events, the federal government has determined it is time to establish “national emergency preparedness requirements to ensure adequate planning for both natural and man-made disasters.”  However, because the federal government does not possess the authority to mandate or enforce federal emergency preparedness standards, they are using a rather creative way to accomplish this objective. 

Release of the CMS Emergency Preparedness Rule

On September 8, 2016, the Centers for Medicare and Medicaid (CMS) posted a final rule entitled Emergency Preparedness Requirements for Medicare and Medicaid Participating Providers and Suppliers. In addition to requiring thousands of healthcare facilities to set up emergency preparedness standards for the first time, these new rules also promote coordination between federal, state, tribal, regional and local emergency preparedness systems.

Related: Listen to our panel of industry experts as they help answer common questions about the new CMS Emergency Preparedness Regulations.

As these standards will now be incorporated into the respective “Conditions of Participation” for these provider types, they are in fact enforceable, and failure to comply can be grounds for reduced “5-star rating” grades (Nursing Home Compare, Hospital Compare, Home Health Compare, and so forth), adversely impacted reimbursement rates, or even termination from participation in the Medicare program. 

Although these standards are being adopted as Medicare Conditions of Participation, they are, as a practical matter, new national standards. Since it is virtually impossible to exist as a healthcare provider or organization without participating in Medicare, these become national standards enforceable by Medicare. Due to the time constraints and financial impact of these new emergency preparedness regulations, facilities such as hospitals and ambulatory surgical centers won’t just enforce the standards as they relate to Medicare or Medicaid patients: these standards are going to impact all patients in these facilities.

Diving deeper on the variety of provider types impacted, noticeably missing from the list are individual medical professional offices or practices. This is primarily due to the fact that CMS does not have any conditions of participation in place for a private medical practice or individual physician when it comes to participating in the Medicare program. Because Medicare does not have a formal inspection process for a physician’s office to participate in Medicare, the Agency has no way to mandate adoption of these standards and enforce consequences for failure to adhere.  Subsequently, these standards only apply to providers who participate in the Medicare program via a formal Medicare participation agreement. 

As such, the providers listed above are all currently adhering to a myriad of facility-specific Medicare requirements known as either “conditions of participation” or “conditions of certification.”  

Conclusion of CMS Emergency Preparedness Rule

After much input from stakeholder groups representing these provider types, CMS developed standards that recognize the diversity amongst these groups and developed emergency preparedness standards that are appropriate for each provider type. Although all will have to develop a new universal emergency preparedness plan, each provider type has some flexibility or exemption from certain other standards that might not be applicable to their situation. 

Technically, the new regulations go into effect on November 16, 2016. Fortunately, CMS is delaying enforcement of these regulations for one-year, making the official compliance date November 16, 2017. For everyone to whom the regulations apply, this provides a one year cushion to adopt and implement  a plan that complies with the new rules. As these plans will significantly impact workflows, this one year buffer could be just what your organization needs for a seamless transition.